Provider Demographics
NPI:1942362082
Name:CAVO, MICHELLE L (PA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:CAVO
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Gender:F
Credentials:PA
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Mailing Address - Street 1:125 LASALLE RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2322
Mailing Address - Country:US
Mailing Address - Phone:860-906-1289
Mailing Address - Fax:860-906-1269
Practice Address - Street 1:125 LASALLE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2322
Practice Address - Country:US
Practice Address - Phone:860-906-1289
Practice Address - Fax:860-906-1269
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2013-08-19
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Provider Licenses
StateLicense IDTaxonomies
CT000862363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant