Provider Demographics
NPI:1114109212
Name:MENDES, ASANTE KOFI (MD)
Entity Type:Individual
Prefix:DR
First Name:ASANTE
Middle Name:KOFI
Last Name:MENDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 SIMSBURY RD
Mailing Address - Street 2:BLDG 9; 2ND FL
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3777
Mailing Address - Country:US
Mailing Address - Phone:860-269-3101
Mailing Address - Fax:860-269-3102
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-0001
Practice Address - Country:US
Practice Address - Phone:860-679-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0460422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry