Healthcare Provider Details

I. General information

NPI: 1689537284
Provider Name (Legal Business Name): AQUASHA RAMBHAROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHAWS CV
NEW LONDON CT
06320-4902
US

IV. Provider business mailing address

29 MAYFLOWER CT
GROTON CT
06340-5219
US

V. Phone/Fax

Practice location:
  • Phone: 860-447-8304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number216476
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: