Healthcare Provider Details

I. General information

NPI: 1902723471
Provider Name (Legal Business Name): DJIGUIBA KAMARA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 MAIN ST
STRATFORD CT
06614-3634
US

IV. Provider business mailing address

4640 MAIN ST
STRATFORD CT
06614-3634
US

V. Phone/Fax

Practice location:
  • Phone: 203-979-1070
  • Fax:
Mailing address:
  • Phone: 646-287-8990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: