Provider Demographics
NPI:1750842951
Name:AFREDE, MOMINA (DO)
Entity Type:Individual
Prefix:
First Name:MOMINA
Middle Name:
Last Name:AFREDE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 HARTFORD TPKE STE 210
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4841
Mailing Address - Country:US
Mailing Address - Phone:860-533-4611
Mailing Address - Fax:
Practice Address - Street 1:428 HARTFORD TPKE STE 210
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4841
Practice Address - Country:US
Practice Address - Phone:860-533-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2023-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT71681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine