Healthcare Provider Details

I. General information

NPI: 1336064690
Provider Name (Legal Business Name): STEPHANIE TANG WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 PHOENIX AVE
WATERBURY CT
06702-1418
US

IV. Provider business mailing address

80 PHOENIX AVE STE 201
WATERBURY CT
06702-1418
US

V. Phone/Fax

Practice location:
  • Phone: 203-756-8021
  • Fax:
Mailing address:
  • Phone: 203-756-8021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number17861
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: