Provider Demographics
NPI:1023470721
Name:MISHRA, NISHANT KUMAR (MBBS PHD)
Entity type:Individual
Prefix:DR
First Name:NISHANT
Middle Name:KUMAR
Last Name:MISHRA
Suffix:
Gender:M
Credentials:MBBS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 208018
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8018
Mailing Address - Country:US
Mailing Address - Phone:203-737-1057
Mailing Address - Fax:203-737-4382
Practice Address - Street 1:800 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1369
Practice Address - Country:US
Practice Address - Phone:203-737-1057
Practice Address - Fax:203-737-4382
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT687392084V0102X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology