Healthcare Provider Details

I. General information

NPI: 1760643407
Provider Name (Legal Business Name): SUDHANSHU BHARAT MULAY MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WOODLAND STREET / CANCER CENTER SAINT FRANCIS MEDICAL GROUP, INC
HARTFORD CT
06105-0000
US

IV. Provider business mailing address

114 WOODLAND ST / CANCER CENTER SAINT FRANCIS MEDICAL GROUP INC
HARTFORD CT
06105-1208
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-5554
  • Fax:
Mailing address:
  • Phone: 860-714-5554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number052812
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: