Individual
AMANDA CAMPBELL OSTAPOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-8016
Mailing address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-8016
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
002851
CT
363AM0700X
Medical Physician Assistant
Primary
002851
CT
363AS0400X
Surgical Physician Assistant
002851
CT
Other
Enumeration date
11/05/2012
Last updated
04/25/2016
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