Healthcare Provider Details

I. General information

NPI: 1023929825
Provider Name (Legal Business Name): YVONNE COLON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YVONNE PORTILLO

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JUDITH TER
STRATFORD CT
06614-1051
US

IV. Provider business mailing address

200 JUDITH TER
STRATFORD CT
06614-1051
US

V. Phone/Fax

Practice location:
  • Phone: 203-551-4924
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number128526
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: