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Individual

MRS. JACQUELINE MCSALLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
5520 PARK AVE, TRUMBULL, CT 06611-3463
(203) 261-7262
Mailing address
1290 SILAS DEANE HWY, HHC CVO, WETHERSFIELD, CT 06109-4337
(860) 972-5507
(860) 972-7040

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-08914
NC
363A00000X
Physician Assistant
7737-023
WI
363AS0400X
Surgical Physician Assistant
Primary
6876
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100274093
WI
01
110-622-459
AMERICAN ACADEMY OF PAS (AAPA)
01
1159850
NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS (NCCPA)
Enumeration date
03/03/2019
Last updated
10/07/2025
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