Healthcare Provider Details

I. General information

NPI: 1538196860
Provider Name (Legal Business Name): STACY LYN SPOONER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOWARD AVE YALE PHYSICIANS BLDG
NEW HAVEN CT
06519-1369
US

IV. Provider business mailing address

101 N PLAINS INDUSTRIAL RD
WALLINGFORD CT
06492-2360
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2140
  • Fax: 203-785-6414
Mailing address:
  • Phone: 203-949-2700
  • Fax: 203-949-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number044323
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: