Healthcare Provider Details

I. General information

NPI: 1407808645
Provider Name (Legal Business Name): ABDELMONIM AFFANY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WATERVILLE RD
AVON CT
06001-2097
US

IV. Provider business mailing address

21 WATERVILLE RD
AVON CT
06001-2097
US

V. Phone/Fax

Practice location:
  • Phone: 860-674-2691
  • Fax: 860-677-6443
Mailing address:
  • Phone: 860-674-2691
  • Fax: 860-677-6443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number043447
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: