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General NPI Number Information
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NPI Number | 1881850360
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Entity Type | Individual
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Provider Name | JASON VELASCO M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 12/04/2019
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Provider Practice Location Address
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Address Line | 87 WEST ST
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City | DANBURY
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State | CT
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Zip | 06810-6528
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Country | US
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Telephone | 203-205-2623
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Fax | 203-794-1501
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Provider Business Mailing Address
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Address Line | 75 WEST ST
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City | DANBURY
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State | CT
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Zip | 06810-6528
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Country | US
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Telephone | 203-205-2623
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Fax | 203-794-1501
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 64095
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 250287
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License Number State | NY
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