Healthcare Provider Details

I. General information

NPI: 1851542369
Provider Name (Legal Business Name): FLORA M. VACCARINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S FRONTAGE RD CHILD STUDY CENTER
NEW HAVEN CT
06519-1124
US

IV. Provider business mailing address

230 S FRONTAGE RD CHILD STUDY CENTER
NEW HAVEN CT
06519-1124
US

V. Phone/Fax

Practice location:
  • Phone: 203-737-4147
  • Fax:
Mailing address:
  • Phone: 203-737-4147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number030286
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: