Healthcare Provider Details

I. General information

NPI: 1598316036
Provider Name (Legal Business Name): TYASIA YONEASE LEFEVER RN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MORGAN ST
STAMFORD CT
06905-5431
US

IV. Provider business mailing address

130 MORGAN ST
STAMFORD CT
06905-5431
US

V. Phone/Fax

Practice location:
  • Phone: 516-505-7200
  • Fax:
Mailing address:
  • Phone: 516-505-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12.017657
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: