Provider Demographics
NPI:1942730213
Name:MISTRY, ANISHA (PA-C)
Entity Type:Individual
Prefix:
First Name:ANISHA
Middle Name:
Last Name:MISTRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234A BANK ST FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-6065
Mailing Address - Country:US
Mailing Address - Phone:860-442-0290
Mailing Address - Fax:
Practice Address - Street 1:234A BANK ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-6065
Practice Address - Country:US
Practice Address - Phone:860-442-0290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021057363A00000X
CT4292363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant