Individual
MIKAELA ROSE COADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
464 CONGRESS AVE STE 260, NEW HAVEN, CT 06519-1362
(203) 785-4404
(203) 785-4580
Mailing address
464 CONGRESS AVE STE 260, NEW HAVEN, CT 06519-1362
(203) 785-4404
(203) 785-4580
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
4946
CT
363AM0700X
Medical Physician Assistant
Primary
4946
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1169367
NCCPA NATIONAL CERTIFICATION
—
01
—
4946
STATE LICENSE
CT
Enumeration date
10/06/2020
Last updated
11/11/2020
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