Mirjana J Domakonda, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

055758 Issued in CT

Practice address

200 Retreat Ave
Hartford, CT 06106-3309

Phone

(860) 545-7493

NPI assigned

Jun 3, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: mdomakonda37955@connecticutchildrens.direct-ci.com
• Direct secure messaging: mirjana.domakonda@xdr.hhchealthdirect.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662681600000",
    "number": "1275853178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 RETREAT AVE",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061063309",
            "telephone_number": "860-545-7493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 RETREAT AVE",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061063309",
            "telephone_number": "860-545-7493"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1320 York Ave",
            "address_2": "25J",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100214800",
            "country_code": "US",
            "telephone_number": "973-750-8346",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "282 Washington St",
            "address_purpose": "LOCATION",
            "city": "Hartford",
            "state": "CT",
            "postal_code": "061063322",
            "country_code": "US",
            "telephone_number": "860-545-9200",
            "fax_number": "860-545-9202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMAKONDA",
        "first_name": "MIRJANA",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-03",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "244741",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "055758",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CT",
            "license": "055758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275853178",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brianne Doherty
• Connor Doherty, PA-C
• Donias Doko, MD
• Cheryl Lynn Doll, APRN
• Hannah Dollhopf
• Lynn Marie Domingos
• Alessia C Donadio, M.D.
• Amelia Donahoe, M.S. CCC-SLP
• Ann Ridley Donahue, APRN
• Gabriella Donais, PA-C

• Child & Adolescent Psychiatry Physician in Hartford, CT
• Providers in Hartford, CT by specialty
• Child & Adolescent Psychiatry Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.