Provider Demographics
NPI:1902424393
Name:DESROCHES, HEATHER (PA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DESROCHES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:31 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2363
Mailing Address - Country:US
Mailing Address - Phone:860-302-9414
Mailing Address - Fax:203-239-3047
Practice Address - Street 1:954 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-7727
Practice Address - Country:US
Practice Address - Phone:203-481-0003
Practice Address - Fax:855-496-0993
Is Sole Proprietor?:No
Enumeration Date:2020-07-11
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT6363363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant