Provider Demographics
NPI:1598904161
Name:PARRILLO, STEPHANIE BENEDICT (PA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BENEDICT
Last Name:PARRILLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 DIXWELL AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-1852
Mailing Address - Country:US
Mailing Address - Phone:203-230-2546
Mailing Address - Fax:
Practice Address - Street 1:2560 DIXWELL AVE STE 2B
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-1852
Practice Address - Country:US
Practice Address - Phone:203-230-2546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002146363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003021466Medicaid