Provider Demographics
NPI:1891263497
Name:JANIGA, MAE EILEEN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MAE
Middle Name:EILEEN
Last Name:JANIGA
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:CT
Mailing Address - Zip Code:06444-0809
Mailing Address - Country:US
Mailing Address - Phone:860-681-8868
Mailing Address - Fax:
Practice Address - Street 1:1075 N FRASER ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-2848
Practice Address - Country:US
Practice Address - Phone:843-527-4442
Practice Address - Fax:843-527-4027
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4333363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant