Healthcare Provider Details

I. General information

NPI: 1083506877
Provider Name (Legal Business Name): DR. PRIYANKA PRASAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 MERIDEN RD
WATERBURY CT
06705-2244
US

IV. Provider business mailing address

360 STATE ST APT 1717
NEW HAVEN CT
06510-3615
US

V. Phone/Fax

Practice location:
  • Phone: 203-753-9503
  • Fax:
Mailing address:
  • Phone: 551-998-8053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14474
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: