Provider Demographics
NPI:1700035615
Name:STANKUS, MARISSA L (PA-C)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:L
Last Name:STANKUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:171 GRANDVIEW AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2520
Mailing Address - Country:US
Mailing Address - Phone:203-578-4630
Mailing Address - Fax:203-578-4629
Practice Address - Street 1:171 GRANDVIEW AVE STE 201
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2520
Practice Address - Country:US
Practice Address - Phone:203-578-4630
Practice Address - Fax:203-578-4629
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2017-10-26
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant