Provider Demographics
NPI:1184641995
Name:CERRITELLI, RHONDA FELICIA-ANN (PA)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:FELICIA-ANN
Last Name:CERRITELLI
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 2828
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06011-2828
Mailing Address - Country:US
Mailing Address - Phone:860-585-3858
Mailing Address - Fax:860-585-3907
Practice Address - Street 1:41 BREWSTER RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5161
Practice Address - Country:US
Practice Address - Phone:860-585-3000
Practice Address - Fax:860-585-3907
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000929363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT222474OtherWELLCARE
CT290000929CT01OtherANTHEM BCBS CT
CTP3226987OtherOXFORD
CT004191938Medicaid
CT9530270OtherAETNA
CT01033818OtherCOVENTRY/FIRST HEALTH
CT004191938Medicaid
CT970001399Medicare PIN