Provider Demographics
NPI:1386908101
Name:MCNIFF, CAITLYN MCNAMARA (PA)
Entity type:Individual
Prefix:MRS
First Name:CAITLYN
Middle Name:MCNAMARA
Last Name:MCNIFF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:MCNAMARA
Other - Last Name:SCHALICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:72 WELLS RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1229
Mailing Address - Country:US
Mailing Address - Phone:203-895-9649
Mailing Address - Fax:
Practice Address - Street 1:464 CONGRESS AVE STE 260
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1362
Practice Address - Country:US
Practice Address - Phone:203-785-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015672363A00000X
CT3605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant