Healthcare Provider Details

I. General information

NPI: 1528634664
Provider Name (Legal Business Name): ELIF YAKUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2021
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 MAIN ST
BRIDGEPORT CT
06606-4201
US

IV. Provider business mailing address

2800 MAIN ST
BRIDGEPORT CT
06606-4201
US

V. Phone/Fax

Practice location:
  • Phone: 475-210-5032
  • Fax:
Mailing address:
  • Phone: 475-210-5032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number86548
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number86548
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: