Healthcare Provider Details

I. General information

NPI: 1336930288
Provider Name (Legal Business Name): VINYAS SHRAFFI VENKATESH MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GRAND ST, HOSPITAL OF CENTRAL CONNECTICUT AMBULATORY MEDICINE CLINIC (AMBULATORY WEST)
NEW BRITAIN CT
06052
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-1921
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-5261
  • Fax: 860-224-5957
Mailing address:
  • Phone: 860-679-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: