Provider Demographics
NPI:1598910697
Name:SFERLAZZA, ROSE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:
Last Name:SFERLAZZA
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 1:4 ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06855-2703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 HIGHLAND AVE
Practice Address - Street 2:SCHOOL BASED HEALTH CENTER AT BMHS
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-4029
Practice Address - Country:US
Practice Address - Phone:203-854-0524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000515363AM0700X
CTMS1653422363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000515OtherSTATE OF CONNECTICUT LICENSE