Provider Demographics
NPI:1962743872
Name:RONCAIOLI, LINDSEY (PA)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:RONCAIOLI
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 1:3 DANIEL ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-1806
Mailing Address - Country:US
Mailing Address - Phone:860-748-7312
Mailing Address - Fax:
Practice Address - Street 1:320 WESTERN BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1259
Practice Address - Country:US
Practice Address - Phone:860-657-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003422363A00000X
MAPA4655363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant