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General NPI Number Information
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NPI Number | 1710818307
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Entity Type | Individual
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Provider Name | DEMRY ROSE GDOVIN PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/25/2026
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Last Update Date | 05/25/2026
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Provider Practice Location Address
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Address Line | 64 ROBBINS ST
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City | WATERBURY
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State | CT
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Zip | 06708-2600
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Country | US
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Telephone | 203-573-6290
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Fax |
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Provider Business Mailing Address
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Address Line | 12 RIVERSIDE DR
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City | WALLINGFORD
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State | CT
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Zip | 06492-5335
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Country | US
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Telephone | 860-461-2167
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | CT
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