Individual
MELISSA DACOSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1290 SILAS DEANE HWY, 2ND FLOOR, WETHERSFIELD, CT 06109-4337
(860) 972-5098
Mailing address
42 TOWN ST, NORWICH, CT 06360-2316
(860) 886-0567
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
CT
363AM0700X
Medical Physician Assistant
Primary
3670
CT
Other
Enumeration date
09/01/2016
Last updated
11/17/2016
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