Provider Demographics
NPI:1518902600
Name:CHATEAUNEUF, DANA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:ANN
Last Name:CHATEAUNEUF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3209
Mailing Address - Country:US
Mailing Address - Phone:203-626-0160
Mailing Address - Fax:203-294-6734
Practice Address - Street 1:84 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3061
Practice Address - Country:US
Practice Address - Phone:203-483-2509
Practice Address - Fax:203-483-2513
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000566363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT872697OtherUSA
CTP00686361OtherRAILROAD MEDICARE
CT290000566CT05OtherANTHEM BCBS CT
CT7362529OtherAETNA
CT1518902600OtherMEDICAID
CT178749OtherWELLCARE
CT970000949Medicare PIN
CTP43717Medicare UPIN