Provider Demographics
NPI:1255658951
Name:ROSSITER, AMY BROWNING CROMPTON (PAC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BROWNING CROMPTON
Last Name:ROSSITER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:BROWNING
Other - Last Name:CROMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 CORPORATE DR STE 386
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6240
Mailing Address - Country:US
Mailing Address - Phone:203-538-5682
Mailing Address - Fax:
Practice Address - Street 1:220 MAIN ST STE 3A
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-1064
Practice Address - Country:US
Practice Address - Phone:203-896-5727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06642363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282283701Medicaid
TXTXB102308Medicare PIN
TXTXB102510Medicare PIN
TXTXB102509Medicare PIN