Provider Demographics
NPI:1891730107
Name:TREADWAY, CANDACE (PA)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:TREADWAY
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 1:14 JONES HOLLOW ROAD
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:CT
Mailing Address - Zip Code:06447
Mailing Address - Country:US
Mailing Address - Phone:860-295-8217
Mailing Address - Fax:860-295-9734
Practice Address - Street 1:14 JONES HOLLOW ROAD
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447
Practice Address - Country:US
Practice Address - Phone:860-295-8217
Practice Address - Fax:860-295-9734
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002028363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant