Healthcare Provider Details

I. General information

NPI: 1215824040
Provider Name (Legal Business Name): STEPHANIE KONSTANDENA YIANITSAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 08/09/2025
Certification Date: 08/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 W AIRPORT FWY STE 215
IRVING TX
75062-5959
US

IV. Provider business mailing address

4441 W AIRPORT FWY STE 215
IRVING TX
75062-5959
US

V. Phone/Fax

Practice location:
  • Phone: 469-440-2667
  • Fax:
Mailing address:
  • Phone: 214-755-4920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: