Healthcare Provider Details

I. General information

NPI: 1093716862
Provider Name (Legal Business Name): DANIELA GIDEA-ADDEO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 PARK ST
NEW HAVEN CT
06519-1110
US

IV. Provider business mailing address

77 LAFAYETTE PLACE RADIATION ONCOLOGY
GREENWICH CT
06830
US

V. Phone/Fax

Practice location:
  • Phone: 203-200-2000
  • Fax: 203-785-4622
Mailing address:
  • Phone: 203-863-3773
  • Fax: 203-863-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number53306
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: