Individual
LATA RAO JAYANTHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
95 SCOVILL ST, 3RD FLOOR, WATERBURY, CT 06706-1113
(203) 709-6000
Mailing address
80 PHOENIX AVE 201, WATERBURY, CT 06702-1418
(203) 756-8021
(203) 596-9038
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
031026
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001310268
—
CT
01
—
010031026CT01
ANTHEM BCBS CT
CT
01
—
09-21728
AMERICHOICE
CT
01
—
310260-N063
CONNECTICARE
CT
01
—
3140536/4383729
AETNA
CT
Enumeration date
06/25/2006
Last updated
03/06/2020
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