Provider Demographics
NPI:1528829769
Name:CONNELLY, FAYTHE (PA-C)
Entity type:Individual
Prefix:
First Name:FAYTHE
Middle Name:
Last Name:CONNELLY
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 14128
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4032
Mailing Address - Country:US
Mailing Address - Phone:248-680-8000
Mailing Address - Fax:248-680-8030
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:STE 260
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1256
Practice Address - Country:US
Practice Address - Phone:248-465-5140
Practice Address - Fax:248-465-5141
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2025-08-12
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant