Provider Demographics
NPI:1285863720
Name:PANTHAKY, FARZANA DARAYUS (LAC)
Entity Type:Individual
Prefix:MRS
First Name:FARZANA
Middle Name:DARAYUS
Last Name:PANTHAKY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 BENHAM AVE
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1627
Mailing Address - Country:US
Mailing Address - Phone:203-631-2615
Mailing Address - Fax:
Practice Address - Street 1:774 ORANGE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2535
Practice Address - Country:US
Practice Address - Phone:203-691-7653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist