Provider Demographics
NPI:1578906731
Name:COLEBURN, NATASHA CHANTAY (PA-C)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:CHANTAY
Last Name:COLEBURN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:150 EILEEN WAY
Mailing Address - Street 2:UNIT 1
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5313
Mailing Address - Country:US
Mailing Address - Phone:866-677-7622
Mailing Address - Fax:404-666-5100
Practice Address - Street 1:80 SEYMOUR ST
Practice Address - Street 2:SUITE 502
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06102-8000
Practice Address - Country:US
Practice Address - Phone:860-545-0549
Practice Address - Fax:860-545-5221
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2018-01-29
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Provider Licenses
StateLicense IDTaxonomies
CT002906363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002906OtherLICENSE