Provider Demographics
NPI:1811157431
Name:TABASSUM, WAZIDA (DC)
Entity type:Individual
Prefix:DR
First Name:WAZIDA
Middle Name:
Last Name:TABASSUM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 BUCKLAND HILLS DR
Mailing Address - Street 2:APT 11232
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-8704
Mailing Address - Country:US
Mailing Address - Phone:203-209-4788
Mailing Address - Fax:
Practice Address - Street 1:74 PARK RD
Practice Address - Street 2:SUITE # 4
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1853
Practice Address - Country:US
Practice Address - Phone:860-218-1725
Practice Address - Fax:860-218-1727
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001764111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation