Provider Demographics
NPI:1275053530
Name:EBBS, DANIEL (DO, MS, NRP)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:EBBS
Suffix:
Gender:M
Credentials:DO, MS, NRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:YALE UNIVERSITY
Mailing Address - Street 2:20 YORK STREET
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-8761
Mailing Address - Country:US
Mailing Address - Phone:408-691-1480
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:408-691-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT66531208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16728OtherCA LICENSE