Organization
EAST HARTFORD PEDIATRIC, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAYASHREE VENKATESH M.D. (PHYSICIAN)
(860) 289-3047
Entity
Organization
Contact information
Practice address
893 MAIN ST, SUITE 303, EAST HARTFORD, CT 06108-2292
(860) 289-3047
(860) 528-4735
Mailing address
21 PAUL SPRING RD, FARMINGTON, CT 06032
(860) 676-1135
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
034733
CT
363LP0200X
Pediatric Nurse Practitioner
002155
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001347336
—
CT
05
—
008035516
—
CT
Enumeration date
08/11/2006
Last updated
12/02/2014
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