Basic Information
| Provider Information | |||||||||
| NPI: | 1831387596 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GENDRON | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PHYSICIAN ASSISTANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1290 SILAS DEANE HWY | ||||||||
| Address2: | |||||||||
| City: | WETHERSFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061094337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609729033 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1244 STORRS RD | ||||||||
| Address2: | |||||||||
| City: | STORRS | ||||||||
| State: | CT | ||||||||
| PostalCode: | 062682200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604569720 | ||||||||
| FaxNumber: | 8604879684 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 06/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 002081 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.