Healthcare Provider Details

I. General information

NPI: 1083354534
Provider Name (Legal Business Name): FREDERIQUE SIROIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-1921
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9000
  • Fax:
Mailing address:
  • Phone: 860-679-2147
  • Fax: 860-679-4624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number82821
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: