Nicole Mya Dimasso, PA-C
Physician Assistant, Surgical in Hartford, CT. Individual provider (NPI-1).
NPI number1104544352
StatusActive
Last updated in NPPESNov 15, 2022
Details
- NPI
- 1104544352
- Entity type
- Individual (NPI-1)
- Name
- Nicole Mya Dimasso
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Aug 15, 2022
- Certification date
- Nov 15, 2022
- Last updated
- Nov 15, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AS0400X | Physician Assistant, Surgical | 005871 | CT | Yes |
Practice location
80 Seymour StHartford, CT 06102-8000
Phone 860-972-5022
Mailing address
80 Seymour StHartford, CT 06102-8000
Phone 860-972-5022
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