Individual
IWONA STACHELEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
71 HAYNES ST, MANCHESTER, CT 06040-4188
(860) 646-1222
Mailing address
334 ATKINS ST, MIDDLETOWN, CT 06457-1534
(860) 593-1095
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5432
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5432
STATE OF CT
CT
Enumeration date
10/10/2021
Last updated
10/10/2021
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