Provider Demographics
NPI:1932684974
Name:ZUGIBE, KAITLYN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:ZUGIBE
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 1:30 BUXTON FARM RD STE 230
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1206
Mailing Address - Country:US
Mailing Address - Phone:203-914-1900
Mailing Address - Fax:
Practice Address - Street 1:30 BUXTON FARM RD STE 230
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1206
Practice Address - Country:US
Practice Address - Phone:203-914-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022600363A00000X
NJ25MP00578000363A00000X
CT4257363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant