Healthcare Provider Details

I. General information

NPI: 1265198394
Provider Name (Legal Business Name): YIANNI YIANNAKOU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 PARK AVE
FAIRFIELD CT
06825-1000
US

IV. Provider business mailing address

5151 PARK AVE
FAIRFIELD CT
06825-1000
US

V. Phone/Fax

Practice location:
  • Phone: 203-371-7999
  • Fax:
Mailing address:
  • Phone: 203-371-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: