Provider Demographics
NPI:1396041539
Name:ABRAHAM, GINEESHA A (APRN)
Entity Type:Individual
Prefix:
First Name:GINEESHA
Middle Name:A
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-5427
Mailing Address - Country:US
Mailing Address - Phone:203-659-7393
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:SMILOW CANCER HOSPITAL, BREAST CENTRE
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-200-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-06
Last Update Date:2011-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4596364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology