Provider Demographics
NPI:1982050829
Name:FORSON-DARE, ZANETA ABA BENTSIWA
Entity Type:Individual
Prefix:DR
First Name:ZANETA
Middle Name:ABA BENTSIWA
Last Name:FORSON-DARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 YORK STREET
Mailing Address - Street 2:LLC 302
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-6925
Mailing Address - Country:US
Mailing Address - Phone:203-785-4651
Mailing Address - Fax:203-785-6925
Practice Address - Street 1:1 PARK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06504-8901
Practice Address - Country:US
Practice Address - Phone:203-785-4081
Practice Address - Fax:203-737-7635
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT640102080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program