Provider Demographics
NPI:1487626065
Name:NYANIN, ADWOA P (MD)
Entity Type:Individual
Prefix:
First Name:ADWOA
Middle Name:P
Last Name:NYANIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 LEWIS AVE
Mailing Address - Street 2:HOSPITALIST PROGRAM
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451
Mailing Address - Country:US
Mailing Address - Phone:203-694-8566
Mailing Address - Fax:
Practice Address - Street 1:435 LEWIS AVE
Practice Address - Street 2:HOSPITALIST PROGRAM
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451
Practice Address - Country:US
Practice Address - Phone:203-694-8566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039364208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001393644Medicaid
CTP00057744OtherRAILROAD MEDICARE
CTP00057744OtherRAILROAD MEDICARE
CT110008712Medicare PIN