Healthcare Provider Details

I. General information

NPI: 1356260152
Provider Name (Legal Business Name): TERENIA OBENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 JORDAN LN
WETHERSFIELD CT
06109-1105
US

IV. Provider business mailing address

204 JORDAN LN
WETHERSFIELD CT
06109-1105
US

V. Phone/Fax

Practice location:
  • Phone: 917-553-9465
  • Fax:
Mailing address:
  • Phone: 917-553-9465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number209494
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: