Healthcare Provider Details

I. General information

NPI: 1457056913
Provider Name (Legal Business Name): TREVOR JOHN WYAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL DRIVE DEPT OF CARDIOLOGY
FARMINGTON CT
06030-0001
US

IV. Provider business mailing address

100 HOSPITAL DRIVE DEPT OF CARDIOLOGY
FARMINGTON CT
06030-0001
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberWYAN3284428
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: