Individual
MOJDEH HEIDARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
10 PRINCETON ST, WEST HARTFORD, CT 06110-1893
(860) 707-5392
Mailing address
360 BLOOMFIELD AVE, WINDSOR, CT 06095-2700
(860) 707-5392
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
106074
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106074
RN
CT
Enumeration date
01/24/2019
Last updated
01/25/2024
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