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General NPI Number Information
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NPI Number | 1477609030
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Entity Type | Individual
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Provider Name | MELISSA GERARDI FAIRBAIRN PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 35 PARK STREET NORTH PAVILLION, 1ST FLOOR
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City | NEW HAVEN
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State | CT
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Zip | 06511
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Country | US
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Telephone | 203-200-4176
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Fax |
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Provider Business Mailing Address
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Address Line | 28 RUSSETT RD
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City | SANDY HOOK
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State | CT
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Zip | 06482-1455
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Country | US
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Telephone | 203-528-8870
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3303
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3303
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License Number State | CT
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