Healthcare Provider Details

I. General information

NPI: 1427498120
Provider Name (Legal Business Name): ASHA DUSAD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 KANE ST
WEST HARTFORD CT
06119-2110
US

IV. Provider business mailing address

1300 HALL BLVD 3RD FLOOR, POD D
BLOOMFIELD CT
06002-2918
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-2730
  • Fax:
Mailing address:
  • Phone: 860-714-2338
  • Fax: 860-714-8612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number55386
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: