Individual
AMANDA CATHERINE EDISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
157 STOCKADE RD, SOUTH GLASTONBURY, CT 06073-2118
(860) 331-0060
Mailing address
157 STOCKADE RD, SOUTH GLASTONBURY, CT 06073-2118
(860) 331-0060
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5583
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/16/2021
Last updated
02/23/2022
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