Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 64867 | CT |
NPI | 1316320534 |
---|---|
Provider Name | Devon Banda |
First Address | Rochester, MI 48307-1522 |
Second Address | Glastonbury, CT 06033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2015 |
Last Update Date | 02/07/2020 |