Provider Demographics
NPI:1508161969
Name:TALATI, MISTI (PA)
Entity Type:Individual
Prefix:
First Name:MISTI
Middle Name:
Last Name:TALATI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 BURNSIDE AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-2406
Mailing Address - Country:US
Mailing Address - Phone:860-528-7161
Mailing Address - Fax:
Practice Address - Street 1:478 BURNSIDE AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2406
Practice Address - Country:US
Practice Address - Phone:860-528-7161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002447363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical