Healthcare Provider Details

I. General information

NPI: 1568091031
Provider Name (Legal Business Name): PATRISA BUSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-0001
US

IV. Provider business mailing address

PO BOX 4580
WATERBURY CT
06704-0580
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-4988
  • Fax:
Mailing address:
  • Phone: 203-623-7209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number73198
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number73198
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: