Provider Demographics
NPI:1508369166
Name:GYASI, STEPHANY BOAFO (CNP)
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:BOAFO
Last Name:GYASI
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-8095
Mailing Address - Country:US
Mailing Address - Phone:860-788-6404
Mailing Address - Fax:860-398-6441
Practice Address - Street 1:84 STATE STRRET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-2202
Practice Address - Country:US
Practice Address - Phone:860-788-6404
Practice Address - Fax:860-398-6441
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2305708363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily