Provider Demographics
NPI:1164494407
Name:OLBRYS, MICHELE MCCANN (PA)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:MCCANN
Last Name:OLBRYS
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 1:372 DANBURY RD STE 197
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-2523
Mailing Address - Country:US
Mailing Address - Phone:203-276-3363
Mailing Address - Fax:203-276-3367
Practice Address - Street 1:372 DANBURY RD STE 197
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-2523
Practice Address - Country:US
Practice Address - Phone:203-276-3363
Practice Address - Fax:203-276-3367
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001326363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT326001OtherCONNECTICARE
CTP86898Medicare UPIN
CT290001326CT01OtherANTHEM BC/BS
CT2V1728OtherACS/HEALTHNET
CTP00006957OtherRAILROAD MEDICARE
CTP2801748OtherOXFORD