Provider Demographics
NPI:1487195384
Name:PARIDIS, MIROFORA
Entity Type:Individual
Prefix:
First Name:MIROFORA
Middle Name:
Last Name:PARIDIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRO
Other - Middle Name:
Other - Last Name:PARIDIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:828 NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3675
Mailing Address - Country:US
Mailing Address - Phone:203-815-2942
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:YALE NEW HAVEN HOSPITAL SOUTH PAVILION 218
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3845363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical