Individual
KIMIKO WYSOCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1250 SILVER ST, MIDDLETOWN, CT 06457-3946
(860) 346-0300
Mailing address
17 YARMOUTH ST, LONGMEADOW, MA 01106-3224
(413) 348-5648
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
6210
CT
Other
Enumeration date
05/30/2023
Last updated
08/07/2023
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