Provider Demographics
NPI:1235577792
Name:PROZORA, STEPHANIE DIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:DIANA
Last Name:PROZORA
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Gender:F
Credentials:MD
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Mailing Address - Street 1:20 YORK ST # T-209
Mailing Address - Street 2:YALE-NEW HAVEN HOSPITAL
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-785-3898
Mailing Address - Fax:203-737-2461
Practice Address - Street 1:20 YORK ST # T-209
Practice Address - Street 2:YALE-NEW HAVEN HOSPITAL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-785-3898
Practice Address - Fax:203-737-2461
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT390200000X
CT554422080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program