Provider Demographics
NPI:1780054056
Name:BROWN, SAMELA MARIANO (PA-C)
Entity type:Individual
Prefix:
First Name:SAMELA
Middle Name:MARIANO
Last Name:BROWN
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 1:1753 MERIDEN-WATERBURY TPKE
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479
Mailing Address - Country:US
Mailing Address - Phone:860-621-5554
Mailing Address - Fax:860-621-3833
Practice Address - Street 1:1753 MERIDEN-WATERBURY TPKE
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479
Practice Address - Country:US
Practice Address - Phone:860-621-5554
Practice Address - Fax:860-621-3833
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT23.003429363AM0700X
CT003429363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant