Individual
AMANDA J CULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
80 SEYMOUR STREET, HARTFORD HOSPITAL SURGERY DEPT, HARTFORD, CT 06102
(860) 545-2840
Mailing address
PO BOX 415933, HARTFORD HOSPITAL PROFESSIONAL SERVICES, BOSTON, MA 02241-5933
(860) 545-7602
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
002006
CT
363AS0400X
Surgical Physician Assistant
Primary
2006
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003020062
—
CT
Enumeration date
11/17/2007
Last updated
03/04/2020
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