Healthcare Provider Details

I. General information

NPI: 1376927921
Provider Name (Legal Business Name): HUMNAH KHUDAYAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 LEWIS AVE
MERIDEN CT
06451-2121
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-8082
US

V. Phone/Fax

Practice location:
  • Phone: 203-238-9446
  • Fax:
Mailing address:
  • Phone: 860-679-8300
  • Fax: 860-679-8344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number066828
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number66828
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number066828
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: