Healthcare Provider Details

I. General information

NPI: 1578806758
Provider Name (Legal Business Name): AMANDA DINSMORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 NORTH ST STE 415
DANBURY CT
06810-5629
US

IV. Provider business mailing address

57 NORTH ST STE 415
DANBURY CT
06810-5629
US

V. Phone/Fax

Practice location:
  • Phone: 203-794-0117
  • Fax:
Mailing address:
  • Phone: 203-794-0117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number66679
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: