Provider Demographics
NPI:1114085461
Name:BANDANZA, ROSINA I (MD)
Entity Type:Individual
Prefix:
First Name:ROSINA
Middle Name:I
Last Name:BANDANZA
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 1:95 THOMASTON AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-1007
Mailing Address - Country:US
Mailing Address - Phone:203-805-5300
Mailing Address - Fax:203-805-5310
Practice Address - Street 1:95 THOMASTON AVE
Practice Address - Street 2:WESTERN CONNECTICUT MENATL HEALTH NETWORK
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1007
Practice Address - Country:US
Practice Address - Phone:203-805-5300
Practice Address - Fax:203-805-5310
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0338862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G03331Medicare UPIN