Individual
CARLY KRISAVAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
161 BOSTON AVE, BRIDGEPORT, CT 06610-1662
(203) 333-4400
(203) 334-0729
Mailing address
11 STONEFIELD DR, PROSPECT, CT 06712-1744
(203) 592-4376
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4141
CT
Other
Enumeration date
07/02/2018
Last updated
01/13/2020
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