Healthcare Provider Details

I. General information

NPI: 1881313989
Provider Name (Legal Business Name): MARIA AUGUSTA SANTOS MONTENEGRO MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK STREET (YALE NEW HAVEN HOSPITAL)
NEW HAVEN CT
06510
US

IV. Provider business mailing address

20 YORK STREET (YALE NEW HAVEN HOSPITAL)
NEW HAVEN CT
06510
US

V. Phone/Fax

Practice location:
  • Phone: 858-306-2510
  • Fax:
Mailing address:
  • Phone: 858-309-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number83149
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA199057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: