Provider Demographics
NPI:1497052385
Name:YANAWAY, TERRY O'NEILL (AUD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:O'NEILL
Last Name:YANAWAY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 BOLTON RD
Mailing Address - Street 2:UNIT 1085
Mailing Address - City:STORRS MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06269-1085
Mailing Address - Country:US
Mailing Address - Phone:860-486-2629
Mailing Address - Fax:860-486-4948
Practice Address - Street 1:850 BOLTON RD
Practice Address - Street 2:UNIT 1085
Practice Address - City:STORRS MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06269-1085
Practice Address - Country:US
Practice Address - Phone:860-486-2629
Practice Address - Fax:860-486-4948
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT278231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1497052385Medicaid