Provider Demographics
NPI:1134312994
Name:KHORASANIZADEH, SADAF (MD)
Entity Type:Individual
Prefix:DR
First Name:SADAF
Middle Name:
Last Name:KHORASANIZADEH
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 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 4304
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-522-3711
Mailing Address - Fax:860-493-1885
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 4304
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-522-3711
Practice Address - Fax:860-493-1885
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0467762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology