Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0201X | Gynecologic Oncologist | 261553 | NY |
Y | 207VX0201X | Gynecologic Oncologist | 56675 | CT |
NPI | 1518175173 |
---|---|
Provider Name | Dr. Melissa Susan Henretta |
First Address | West Hartford, CT 06117-2935 |
Second Address | Hartford, CT 06105-1208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 17/03/2018 |