Provider Demographics
NPI:1528542628
Name:CANNATA, CHRISTINE MCVAY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MCVAY
Last Name:CANNATA
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 1:10 SOUTH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4125
Mailing Address - Country:US
Mailing Address - Phone:203-431-4600
Mailing Address - Fax:203-431-4601
Practice Address - Street 1:10 SOUTH ST STE 101
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4125
Practice Address - Country:US
Practice Address - Phone:203-431-4600
Practice Address - Fax:203-431-4601
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT23.004295363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant