Provider Demographics
NPI:1992959308
Name:BIONDI, ANGELA C (PA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:BIONDI
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:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-0788
Mailing Address - Country:US
Mailing Address - Phone:860-871-8851
Mailing Address - Fax:860-871-8852
Practice Address - Street 1:384 MERROW RD STE K
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3970
Practice Address - Country:US
Practice Address - Phone:860-871-8851
Practice Address - Fax:860-871-8852
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001810363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical