Healthcare Provider Details

I. General information

NPI: 1407962764
Provider Name (Legal Business Name): SARYNA PUTMAN YOUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 03/19/2023
Certification Date: 03/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 HIGH RIDGE RD
STAMFORD CT
06905-3811
US

IV. Provider business mailing address

123 HIGH RIDGE RD
STAMFORD CT
06905-3811
US

V. Phone/Fax

Practice location:
  • Phone: 475-400-9455
  • Fax: 952-209-9802
Mailing address:
  • Phone: 475-400-9455
  • Fax: 952-209-9802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number240336
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number044445
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number044445
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: