NPI 1063282853 · live from the CMS NPI Registry
Mishelle Diane Andersen
Physician Assistant in Bridgeport, CT. National Provider Identifier 1063282853, active.
NPI record
| NPI | 1063282853 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 64 Black Rock Ave, Bridgeport, CT 06605 |
| Practice phone | 203-641-6110 |
| Enumerated | January 3, 2024 |
| Last updated | April 3, 2026 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant primary | 363A00000X | 7523 (CT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.