Individual
MANDY A WAINSCOAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
27 SYCAMORE ST, STE 100, PRIME HEALTHCARE, GLASTONBURY, CT 06033-2223
(860) 659-0581
(860) 652-3077
Mailing address
30 JORDAN LN, PRIME HEALTHCARE, WETHERSFIELD, CT 06109-1278
(860) 263-0253
(860) 263-0262
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
042898
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001428988
—
CT
01
—
040042898CT01
BCBS
CT
01
—
042898
MEDICAL LICENSE
CT
Enumeration date
12/23/2005
Last updated
03/20/2023
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