Provider Demographics
NPI:1295202927
Name:DONOYAN, STEPHANIE ERICA (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ERICA
Last Name:DONOYAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MUSSEY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:MANVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02838-1802
Mailing Address - Country:US
Mailing Address - Phone:401-479-0147
Mailing Address - Fax:
Practice Address - Street 1:45 GREEN HOLLOW RD
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-3509
Practice Address - Country:US
Practice Address - Phone:860-779-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004326363A00000X
RIPA01087363A00000X
MAPA6639363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant