Provider Demographics
NPI:1144505538
Name:DELCAVO, AMANDA MARIA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARIA
Last Name:DELCAVO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706
Mailing Address - Country:US
Mailing Address - Phone:203-709-6000
Mailing Address - Fax:
Practice Address - Street 1:50 FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706
Practice Address - Country:US
Practice Address - Phone:203-709-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002616363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP01268782OtherRR MEDICARE
CT008036975Medicaid
CT1158906OtherUSA
CT642587OtherWELLCARE
CTP4447933OtherOXFORD
CT26160OtherCONNECTICARE
CT9840786OtherAETNA
CT642587OtherWELLCARE