Healthcare Provider Details

I. General information

NPI: 1275274409
Provider Name (Legal Business Name): NADHA FATHIMA YAKOOB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2022
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 LONG RIDGE RD STE 21402ND
STAMFORD CT
06902-1638
US

IV. Provider business mailing address

260 LONG RIDGE RD STE 21402ND
STAMFORD CT
06902-1638
US

V. Phone/Fax

Practice location:
  • Phone: 888-461-0106
  • Fax:
Mailing address:
  • Phone: 475-619-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number80753
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: