Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ebtisam Faddoul, PA-C

Individual provider Physician Assistant · NPI 1114294055

Ebtisam Faddoul, PA-C is a Physician Assistant in Stamford, Connecticut. Graduated from Mercy College in 2011, 15 years ago. Practices with Stamford Health Medical Group Inc, a 432-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in New York.

Years since qualifying
15
Trained at
Mercy College
Licensed in
NY
In the registry since
2011
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

29 Hospital Plz Ste 501
Stamford, CT 06902-3602
Phone: (203) 276-4400
Fax: (203) 276-4401
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 111 E 210th St, Bronx, NY 10467-2401 — (718) 920-2985

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 015255-1 (NY)

Record details

NPI number1114294055
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedNovember 21, 2011
Last updated in NPPESJuly 19, 2022
Certification dateJuly 19, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolMERCY COLLEGE
Graduated 2011 (15 years in practice)
Group practice Stamford Health Medical Group Inc — 432 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Stamford