| Mansfield Family Practice Llc | |
|
34 Professional Park Road Storrs CT 06268 | |
| (860) 487-0002 | |
| (860) 429-1663 |
| Full Name | Mansfield Family Practice Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 34 Professional Park Road, Storrs, Connecticut |
| Authorized Official Name and Position | Kelly Wyse (MEDICAL RECORDS) |
| Authorized Official Contact | 8604870002 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mansfield Family Practice Llc 34 Professional Park Road Storrs CT 06268 Ph: (860) 487-0002 | Mansfield Family Practice Llc 34 Professional Park Road Storrs CT 06268 Ph: (860) 487-0002 |
| NPI Number | 1265546956 |
|---|---|
| Provider Enumeration Date | 08/18/2006 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 2961433594 |
|---|---|
| Medicare Enrollment ID | O20050824000185 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265546956 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Connecticut) | Primary |
| Provider Name | Sandra M Hughes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649257700 PECOS PAC ID: 6901889666 Enrollment ID: I20040611001329 |
| Provider Name | Ross Winakor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720071681 PECOS PAC ID: 9032171004 Enrollment ID: I20041102000195 |
| Provider Name | Kenneth Dardick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316930266 PECOS PAC ID: 3274664305 Enrollment ID: I20101011000562 |
| Provider Name | Ayaz T Madraswalla |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902899859 PECOS PAC ID: 5092846121 Enrollment ID: I20101110000003 |
| Provider Name | Tatyana Divino |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780812099 PECOS PAC ID: 6103064225 Enrollment ID: I20131017000954 |
| Provider Name | Jean Elaine Walikonis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215415492 PECOS PAC ID: 2466703145 Enrollment ID: I20180919001120 |
| Provider Name | Jennifer Theresa Pereira |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922718725 PECOS PAC ID: 6103282348 Enrollment ID: I20230515001184 |
Physician Management Services Of Connecticut, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 34 Professional Park Rd, Storrs, CT 06268 Phone: 888-829-8550 | |
Translational Medicine Clinic & Research Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1768 Storrs Rd, Suite A, Storrs, CT 06268 Phone: 860-477-0961 |