Active NPI
Stephanie Mazerolle, PHD, ATC
- Athletic Trainer
- Storrs, CT
National Provider Identifier
1912384272
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 000205
- Practice address
- 2095 Hillside Rd
Unit 1110 Department of Kinesiology
Storrs, CT 06269-1110 - Phone
- (860) 486-4536
- Fax
- (860) 486-1123
- NPI assigned
- May 6, 2015
- Last updated
- May 6, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 000205 | CT | Primary |
Addresses
Primary practice location
2095 Hillside Rd
Unit 1110 Department of Kinesiology
Storrs, CT 06269-1110
Mailing address
41 Whitney Rd
Columbia, CT 06237-1034
Phone (860) 608-4184
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000205 | CT | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430870400000",
"number": "1912384272",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41 WHITNEY RD",
"city": "COLUMBIA",
"state": "CT",
"postal_code": "062371034",
"telephone_number": "860-608-4184"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2095 HILLSIDE RD",
"address_2": "UNIT 1110 DEPARTMENT OF KINESIOLOGY",
"city": "STORRS",
"state": "CT",
"postal_code": "062691110",
"telephone_number": "860-486-4536",
"fax_number": "860-486-1123"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZEROLLE",
"first_name": "STEPHANIE",
"credential": "PHD, ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-05-06",
"last_updated": "2015-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CT",
"license": "000205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Storrs, CT
- Mansfield Acquisition Operator LLC (Mansfield Center for Health and Rehabilitation)
- Mansfield Family Practice LLC
- Mansfield Retirement Community (Juniper Hill Village)
- Patricia Marble, L.M.T.
- Laura Mauroy, LCSW
- Nia J McBride
- Jean Marie McCarthy, MS/CCC-SLP
- Amy McKenzie, MS, ATC, PES
- Ann Carney McMahon, AUD
- Meg Bishop, LCSW, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.