Provider Demographics
NPI:1023858123
Name:MASTROIANNI, ALLISON ROSE (PA)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:ROSE
Last Name:MASTROIANNI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:ROSE
Other - Last Name:DIRAFFAELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5520 PARK AVE STE WP-2300
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3463
Mailing Address - Country:US
Mailing Address - Phone:203-374-0310
Mailing Address - Fax:203-374-0314
Practice Address - Street 1:5520 PARK AVE STE WP-2300
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-3463
Practice Address - Country:US
Practice Address - Phone:203-374-0310
Practice Address - Fax:203-374-0314
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT23.006711363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant