Provider Demographics
NPI:1326773151
Name:LAURICELLA, NICHOLAS A (PA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:A
Last Name:LAURICELLA
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:116 GRIST MILL RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1362
Mailing Address - Country:US
Mailing Address - Phone:203-551-0360
Mailing Address - Fax:
Practice Address - Street 1:115 TECHNOLOGY DR UNIT B201
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6300
Practice Address - Country:US
Practice Address - Phone:203-545-0139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant