Provider Demographics
NPI:1457405524
Name:GAJADHAR, NICOLE JACQUELINE (RPA-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:JACQUELINE
Last Name:GAJADHAR
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Gender:F
Credentials:RPA-C
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Mailing Address - Street 1:1290 SILAS DEANE HWY
Mailing Address - Street 2:HHC CVO
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:860-972-5507
Mailing Address - Fax:860-972-7040
Practice Address - Street 1:30 BUXTON FARM RD STE 210
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1230
Practice Address - Country:US
Practice Address - Phone:203-322-7070
Practice Address - Fax:203-322-2389
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2025-09-29
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Provider Licenses
StateLicense IDTaxonomies
NY011033-1363AM0700X
CT7128363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical