Healthcare Provider Details

I. General information

NPI: 1124723549
Provider Name (Legal Business Name): KEIRSTYN YACCARINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 CENTER ROCK GRN STE 10
OXFORD CT
06478-3170
US

IV. Provider business mailing address

4 ABBOTTS LN
BRANFORD CT
06405-3601
US

V. Phone/Fax

Practice location:
  • Phone: 203-828-6790
  • Fax:
Mailing address:
  • Phone: 203-654-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: