Healthcare Provider Details

I. General information

NPI: 1629905732
Provider Name (Legal Business Name): IYANNA K COLON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 FOUNTAIN ST FL 2
SPRINGFIELD MA
01108-3015
US

IV. Provider business mailing address

314 FOUNTAIN ST
SPRINGFIELD MA
01108-3015
US

V. Phone/Fax

Practice location:
  • Phone: 413-507-9003
  • Fax:
Mailing address:
  • Phone: 413-507-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberSA9160232
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: