Individual
MRS. MARIANNE IRENE REILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
30 SHELBURNE RD, STAMFORD, CT 06902-3628
(203) 276-1000
Mailing address
30 SHELBURNE RD/W BROAD ST, STAMFORD, CT 06904
(203) 276-1000
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
000339
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000339
CT STATE LICENSE
CT
Enumeration date
02/20/2008
Last updated
01/08/2016
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