Provider Demographics
NPI:1447514880
Name:AUDIBERT, LAUREN FIORITO (MMS, PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:FIORITO
Last Name:AUDIBERT
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:FIORITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MMS, PA-C
Mailing Address - Street 1:30 STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3859
Mailing Address - Country:US
Mailing Address - Phone:203-852-2278
Mailing Address - Fax:203-855-3555
Practice Address - Street 1:30 STEVENS ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3859
Practice Address - Country:US
Practice Address - Phone:203-852-2278
Practice Address - Fax:203-855-3555
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015679363A00000X
CT2837363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant