Provider Demographics
NPI:1710069455
Name:CALANDRO, COURTNEY (PA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:CALANDRO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:322 E MAIN ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3136
Mailing Address - Country:US
Mailing Address - Phone:203-488-7228
Mailing Address - Fax:
Practice Address - Street 1:2200 WHITNEY AVE
Practice Address - Street 2:SUITE 360
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3691
Practice Address - Country:US
Practice Address - Phone:203-281-4463
Practice Address - Fax:203-287-2930
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001819363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP01260360OtherRR MEDICARE
CT008017868Medicaid
CT0970002231Medicare NSC
CTD400106818Medicare PIN