Healthcare Provider Details

I. General information

NPI: 1669732756
Provider Name (Legal Business Name): ALLERGY AND ASTHMA FAMILY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 FARMINGTON AVE
WEST HARTFORD CT
06107-2229
US

IV. Provider business mailing address

928 FARMINGTON AVE
WEST HARTFORD CT
06107-2229
US

V. Phone/Fax

Practice location:
  • Phone: 860-233-6293
  • Fax: 860-236-7223
Mailing address:
  • Phone: 860-233-6293
  • Fax: 860-236-7223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAYNA BURKE
Title or Position: OWNER
Credential: MD
Phone: 860-233-6293