Healthcare Provider Details

I. General information

NPI: 1164364691
Provider Name (Legal Business Name): VIVONOVA HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 POST RD STE 200D
FAIRFIELD CT
06824-6057
US

IV. Provider business mailing address

1275 POST RD STE 200D
FAIRFIELD CT
06824-6057
US

V. Phone/Fax

Practice location:
  • Phone: 203-267-9787
  • Fax: 203-549-0651
Mailing address:
  • Phone: 203-267-9787
  • Fax: 203-549-0651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RUTH ASANTE
Title or Position: CEO
Credential:
Phone: 203-267-9787