Provider Demographics
NPI:1558500207
Name:PICIW, KAREN SUE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:SUE
Last Name:PICIW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:SUE
Other - Last Name:DENEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:45 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-1825
Mailing Address - Country:US
Mailing Address - Phone:203-926-9987
Mailing Address - Fax:
Practice Address - Street 1:45 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-1825
Practice Address - Country:US
Practice Address - Phone:203-926-9987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000313363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical