Healthcare Provider Details

I. General information

NPI: 1922835545
Provider Name (Legal Business Name): PREMIER PEDIATRICS OF CONNECTICUT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 DAY HILL RD STE 103
WINDSOR CT
06095-1781
US

IV. Provider business mailing address

9 HUCKLEBERRY RD
WINDSOR CT
06095-1541
US

V. Phone/Fax

Practice location:
  • Phone: 860-580-5229
  • Fax:
Mailing address:
  • Phone: 718-431-4204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. AMMA DARKO
Title or Position: DNP, APRN
Credential: DNP
Phone: 718-431-4204