Healthcare Provider Details

I. General information

NPI: 1619853975
Provider Name (Legal Business Name): IQRA WALAYAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 NEW LONDON TPKE STE 211
GLASTONBURY CT
06033-2246
US

IV. Provider business mailing address

42 TIBER AVE
DEER PARK NY
11729-7012
US

V. Phone/Fax

Practice location:
  • Phone: 860-891-2557
  • Fax:
Mailing address:
  • Phone: 516-853-4685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14800
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: