MEDICARE: MS. ROSE SFERLAZZA 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	363AM0700X	Medical Physician Assistant	000515	CT
2	363AM0700X	Medical Physician Assistant	MS1653422	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000515	OTHER	CT	STATE OF CONNECTICUT LICENSE

General Provider Information

NPI Number	:	1598910697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSE SFERLAZZA PA-C

Provider Business Mailing Address
First Line	:	4 ISLAND DR
Second Line	:
City	:	NORWALK
State	:	CT
Zip	:	06855-2703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 HIGHLAND AVE
Second Line	:	SCHOOL BASED HEALTH CENTER AT BMHS
City	:	NORWALK
State	:	CT
Zip	:	06854-4029
Country	:	US
Telephone Number	:	203-854-0524
Fax Number	:

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

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	11/18/2008

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