Provider Demographics
NPI:1063643369
Name:SAUNDERS, ASHLEY MONDAY (PA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MONDAY
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:WEST CORNWALL
Mailing Address - State:CT
Mailing Address - Zip Code:06796-0062
Mailing Address - Country:US
Mailing Address - Phone:860-672-0148
Mailing Address - Fax:
Practice Address - Street 1:540 LITCHFIELD ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6679
Practice Address - Country:US
Practice Address - Phone:860-496-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002289363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003022894Medicaid
CTD400044255 - C00023Medicare PIN
CTD400044254 - C00814Medicare PIN