Provider Demographics
NPI:1295861599
Name:PINO, GABRIELLE S (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:GABRIELLE
Middle Name:S
Last Name:PINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:GABRIELLE
Other - Middle Name:S
Other - Last Name:TROISI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:23 SHERMAN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5868
Mailing Address - Country:US
Mailing Address - Phone:203-303-7170
Mailing Address - Fax:203-336-0156
Practice Address - Street 1:23 SHERMAN ST STE 101
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5868
Practice Address - Country:US
Practice Address - Phone:203-303-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001811363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical