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General NPI Number Information
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NPI Number | 1902434624
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Entity Type | Individual
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Provider Name | PADMINI CHANNAMSETTY DO
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Gender | Female
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Dates
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Enumeration Date | 03/29/2020
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 280 S MAIN ST STE 103
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City | CHESHIRE
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State | CT
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Zip | 06410-3112
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Country | US
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Telephone | 860-696-2925
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Fax | 860-696-2926
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Provider Business Mailing Address
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Address Line | 1290 SILAS DEANE HWY
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City | WETHERSFIELD
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State | CT
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Zip | 06109-4337
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Country | US
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Telephone | 860-972-9034
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Fax | 860-972-7040
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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 | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 77992
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 77992
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License Number State | CT
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