Provider Demographics
NPI:1053637389
Name:BENNETT, ALYSSA S (MD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:S
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 FARMINGTON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1901
Mailing Address - Country:US
Mailing Address - Phone:860-837-7681
Mailing Address - Fax:860-837-5361
Practice Address - Street 1:599 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2381
Practice Address - Country:US
Practice Address - Phone:860-837-7681
Practice Address - Fax:860-837-5361
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0549252080A0000X, 208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics