Healthcare Provider Details

I. General information

NPI: 1790641868
Provider Name (Legal Business Name): MEENAKSHI RANJITH KOTCHERLAKOTA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2026
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 HEMLOCK AVE STE 103
SOUTH WINDSOR CT
06074-9607
US

IV. Provider business mailing address

216 HEMLOCK AVE STE 103
SOUTH WINDSOR CT
06074-9607
US

V. Phone/Fax

Practice location:
  • Phone: 860-471-8030
  • Fax: 860-244-9143
Mailing address:
  • Phone: 860-471-8030
  • Fax: 860-244-9143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16294
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number228575
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: