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NPI Code Detail

MEDICARE: MRS. AIMEE LYNNE JAQUEZ PAC

MEDICARE: MRS. AIMEE LYNNE JAQUEZ PAC
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
1363A00000XPhysician Assistant1656CT

General Provider Information

NPI Number : 1689710980
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AIMEE LYNNE JAQUEZ PAC
Provider Business Mailing Address
First Line : 2000 POST RD STE 305
Second Line :
City : FAIRFIELD
State : CT
Zip : 06824-5730
Country : US
Telephone Number : 203-349-1438
Fax Number :
Provider Business Practice Location Address
First Line : 32 CHURCH HILL RD
Second Line :
City : NEWTOWN
State : CT
Zip : 06470-1638
Country : US
Telephone Number : 203-491-2999
Fax Number : 203-666-5651
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 03/03/2026

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