Provider Demographics
NPI:1548254774
Name:O'NEILL, REBECCA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WESSELS PL
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6923
Mailing Address - Country:US
Mailing Address - Phone:203-531-7863
Mailing Address - Fax:
Practice Address - Street 1:1177 SUMMER ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5572
Practice Address - Country:US
Practice Address - Phone:203-653-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000766363AS0400X
NY003558363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970002735Medicare PIN