Provider Demographics
NPI:1700130598
Name:RICHETELLI, STEPHANIE A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:A
Last Name:RICHETELLI
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 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 3212
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-522-1171
Mailing Address - Fax:860-493-6524
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 3212
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-522-1171
Practice Address - Fax:860-493-6524
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016210363A00000X
CT002900363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant