Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 049202 | CT |
NPI | 1003100397 |
---|---|
Provider Name | Susmita Senapati |
First Address | Stamford, CT 06903-2415 |
Second Address | Stamford, CT 06905-1610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2011 |
Last Update Date | 01/10/2012 |