Individual
MISS MISHELLE DIANE ANDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
64 BLACK ROCK AVE, BRIDGEPORT, CT 06605-1200
(203) 641-6110
Mailing address
64 BLACK ROCK AVE, BRIDGEPORT, CT 06605-1200
(203) 641-6110
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7523
CT
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
01/03/2024
Last updated
04/03/2026
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