Healthcare Provider Details

I. General information

NPI: 1962080473
Provider Name (Legal Business Name): ANNA MANETTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GRAND ST
NEW BRITAIN CT
06052-2016
US

IV. Provider business mailing address

1210 SILAS DEANE HWY # 106
WETHERSFIELD CT
06109-4328
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-5261
  • Fax: 860-224-5696
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number82485
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: