Provider Demographics
NPI:1376587584
Name:GUZZIO, KIMBERLY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:GUZZIO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:CHEMACKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:99 HAWLEY LN FL 3
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1202
Mailing Address - Country:US
Mailing Address - Phone:860-443-4383
Mailing Address - Fax:860-443-3980
Practice Address - Street 1:196 PARKWAY S
Practice Address - Street 2:SUITE 103
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-1234
Practice Address - Country:US
Practice Address - Phone:860-443-4383
Practice Address - Fax:860-443-3980
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1019207RC0000X
CT001019363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1376587584Medicaid
CT1376587584Medicaid
500HBC444CT01OtherANTHEM/HOSP-BASED ECCD
060064820OtherRR MED/ECCD: 06-1616101
649086OtherCONNECTICARE
P2473100OtherOXFORD/ECCG: 06-1049086
004220654OtherBLUECARE FAMILY PLAN
970016208OtherRR MED/ECCG: 06-1049086
P2524340OtherOXFORD/ECCD: 06-1616101
0V9728OtherHEALTHNET/ECCG:06-1049086
290001019CT03OtherANTHEM/ECCD: 06-1616101
0V9729OtherHEATHNET/ECCD:06-1616101
290001019CT03OtherANTHEM/ECCD: 06-1616101
970016208OtherRR MED/ECCG: 06-1049086