Healthcare Provider Details

I. General information

NPI: 1497448518
Provider Name (Legal Business Name): JENNIFER WADJA AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER ROY

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

988 SILAS DEANE HWY
WETHERSFIELD CT
06109-4227
US

IV. Provider business mailing address

988 SILAS DEANE HWY
WETHERSFIELD CT
06109-4227
US

V. Phone/Fax

Practice location:
  • Phone: 860-493-1950
  • Fax: 860-493-1961
Mailing address:
  • Phone: 860-493-1950
  • Fax: 860-493-1961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number17.000744
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number17.000744
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: