Healthcare Provider Details

I. General information

NPI: 1619790607
Provider Name (Legal Business Name): AVINASH RAJRAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 WOODLAND ST
HARTFORD CT
06105-2363
US

IV. Provider business mailing address

43 WOODLAND ST
HARTFORD CT
06105-2363
US

V. Phone/Fax

Practice location:
  • Phone: 518-281-6077
  • Fax:
Mailing address:
  • Phone: 518-281-6077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number15201
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number829589
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: