Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 054925 | CT |
N | 2080A0000X | Adolescent Medicine | 054925 | CT |
NPI | 1053637389 |
---|---|
Provider Name | Dr. Alyssa S Bennett |
First Address | Farmington, CT 06032-1901 |
Second Address | Farmington, CT 06032-1901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2010 |
Last Update Date | 23/08/2018 |