| NPI | 1700898764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAYASHREE VENKATESH Physician 860-289-3047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: CT 034733) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CT 002155) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2014-12-02 |