{
"Npi": {
"NPI": "1902434624",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CHANNAMSETTY",
"FirstName": "PADMINI",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DO",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1290 SILAS DEANE HWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WETHERSFIELD",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06109-4337",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "860-972-9034",
"MailingAddressFaxNumber": "860-972-7040",
"FirstLinePracticeLocationAddress": "280 S MAIN ST STE 103",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHESHIRE",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06410-3112",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "860-696-2925",
"PracticeLocationAddressFaxNumber": "860-696-2926",
"EnumerationDate": "03/29/2020",
"LastUpdateDate": "08/06/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "208VP0000X",
"TaxonomyName": "Pain Medicine Physician",
"LicenseNumber": "77992",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "390200000X",
"TaxonomyName": "Student in an Organized Health Care Education/Training Program",
"LicenseNumber": null,
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "77992",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}