Provider Demographics
NPI:1942815782
Name:SURTI, KHUSHBOO (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KHUSHBOO
Middle Name:
Last Name:SURTI
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 SULLIVAN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2080
Mailing Address - Country:US
Mailing Address - Phone:860-432-7771
Mailing Address - Fax:860-432-7774
Practice Address - Street 1:925 SULLIVAN AVE STE 2
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2080
Practice Address - Country:US
Practice Address - Phone:860-432-7771
Practice Address - Fax:860-432-7774
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9177363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health