Provider Demographics
NPI:1104300987
Name:CLEMENS, CHELSEA ANN (PA)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ANN
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 STRAWBERRY HILL AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2520
Mailing Address - Country:US
Mailing Address - Phone:203-461-3812
Mailing Address - Fax:
Practice Address - Street 1:304 FEDERAL RD STE 201
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2421
Practice Address - Country:US
Practice Address - Phone:203-740-2593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4250363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant