MEDICARE: MRS. WANDA BRONSTEIN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	2693	CT

General Provider Information

NPI Number	:	1053689489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WANDA BRONSTEIN PA-C

Provider Business Mailing Address
First Line	:	1000 ASYLUM AVE STE 3212
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06105-1702
Country	:	US
Telephone Number	:	860-522-1711
Fax Number	:	860-493-6524

Provider Business Practice Location Address
First Line	:	1000 ASYLUM AVE STE 3212
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06105-1702
Country	:	US
Telephone Number	:	860-522-1171
Fax Number	:	860-493-6524

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2011
Last Update Date	:	08/19/2022

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