Provider Demographics
NPI:1790403855
Name:MONFALCONE, AMANDA MARIE (PA-C)
Entity Type:Individual
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First Name:AMANDA
Middle Name:MARIE
Last Name:MONFALCONE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:5 HIGH RIDGE PARK FL 2
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1332
Mailing Address - Country:US
Mailing Address - Phone:203-869-1145
Mailing Address - Fax:203-618-1721
Practice Address - Street 1:512 SAYBROOK RD STE 100
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4788
Practice Address - Country:US
Practice Address - Phone:860-347-7636
Practice Address - Fax:860-894-1894
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2024-04-22
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Provider Licenses
StateLicense IDTaxonomies
OH000692771363AS0400X
CT6527363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical