Provider Demographics
NPI:1780773861
Name:DAMATO, LORENE SALES (PA)
Entity type:Individual
Prefix:MS
First Name:LORENE
Middle Name:SALES
Last Name:DAMATO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 OSBORNE ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6000
Mailing Address - Country:US
Mailing Address - Phone:203-739-7010
Mailing Address - Fax:203-739-1715
Practice Address - Street 1:24 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6099
Practice Address - Country:US
Practice Address - Phone:203-739-7010
Practice Address - Fax:203-739-1715
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000340363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6018661OtherMVP
CT200340OtherCONNECTICARE
CTS70812Medicare UPIN
CT6018661OtherMVP