Individual ProviderMonika MishraInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address1302 S Main St, Waterbury, CT 06706-1748(203) 756-8021(203) 576-5576PECOS EnrollmentBased on the most recent information from CMS, provider Monika Mishra is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1316333990Provider TypeIndividualFull NameMishra, MonikaGenderFemaleSole ProprietorYesEnumeration Date4/10/2015Last Updated9/19/2019Contact InformationPractice LocationPractice Address1302 S Main St, Waterbury, CT 06706-1748Phone(203) 756-8021FaxUnlisted FaxMailing LocationMailing Address2800 Main St, Bridgeport, CT 06606-4201Phone(203) 576-5576Fax(203) 576-5022Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense57006ConnecticutCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID223160873DescriptionOtherIssuerUNITED HEALTH CAREConnecticutIDD400489070DescriptionOtherIssuerMEDICAREConnecticutID6862292DescriptionOtherIssuerCIGNAConnecticutID6862292DescriptionOtherIssuerAETNAConnecticutID1316333990DescriptionOtherIssuerCONNECTICAREConnecticutID1316333990DescriptionOtherIssuerANTHEM BCBSConnecticutID008081148DescriptionMedicaidIssuerUnlistedConnecticut