Provider Demographics
NPI:1225624562
Name:RYLES, YVETTE STEPHAINE
Entity Type:Individual
Prefix:MISS
First Name:YVETTE
Middle Name:STEPHAINE
Last Name:RYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:YVETTE
Other - Middle Name:STEPHAINE
Other - Last Name:RYLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:YVETTE RYLES
Mailing Address - Street 1:PO BOX 4588
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06147-4588
Mailing Address - Country:US
Mailing Address - Phone:860-671-2617
Mailing Address - Fax:
Practice Address - Street 1:19 GOSLEE DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5810
Practice Address - Country:US
Practice Address - Phone:860-671-2617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT171M00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No171M00000XOther Service ProvidersCase Manager/Care Coordinator