Healthcare Provider Details

I. General information

NPI: 1578676292
Provider Name (Legal Business Name): STEPHANIE R. VAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CHAPEL STREET SAINT RAPHAEL FACULTY PHYSICIANS
NEW HAVEN CT
06511
US

IV. Provider business mailing address

PO BOX 18263 SAINT RAPHAEL FACULTY PHYSICIANS
BRIDGEPORT CT
06601-3263
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-4074
  • Fax: 203-867-5534
Mailing address:
  • Phone: 508-595-0531
  • Fax: 508-829-5367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number041957
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: