Healthcare Provider Details

I. General information

NPI: 1801461405
Provider Name (Legal Business Name): DANIEL MICHEL BIBAWY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 MAIN ST STE 300
SOUTHINGTON CT
06489-2548
US

IV. Provider business mailing address

98 MAIN ST STE 300
SOUTHINGTON CT
06489-2548
US

V. Phone/Fax

Practice location:
  • Phone: 860-276-3970
  • Fax: 860-321-5885
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number76627
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: