NPI 1548930936 · live from the CMS NPI Registry
Michael Constantine Antonellis
Physician Assistant in Bridgeport, CT. National Provider Identifier 1548930936, active.
NPI record
| NPI | 1548930936 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 2800 Main Street Dept Of Surgery, Bridgeport, CT 06606 |
| Practice phone | 475-210-6512 |
| Mailing address | 1290 Silas Deane Hwy, Wethersfield, CT 06109 |
| Enumerated | September 16, 2021 |
| Last updated | July 20, 2026 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant | 363A00000X | — |
| Physician Assistant primary | 363A00000X | 6627 (CT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.