Healthcare Provider Details

I. General information

NPI: 1346059565
Provider Name (Legal Business Name): PETER ANTHONY WASIUK AU.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 STANFORD DR
FARMINGTON CT
06032-2454
US

IV. Provider business mailing address

438 WHITNEY AVE APT 9
NEW HAVEN CT
06511-2349
US

V. Phone/Fax

Practice location:
  • Phone: 860-640-4455
  • Fax:
Mailing address:
  • Phone: 603-944-2874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000732
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: