Provider Demographics
NPI:1659348365
Name:PENA, YOLANDA M (MD)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:M
Last Name:PENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:M
Other - Last Name:PENA-WALZAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:40 DALE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3692
Mailing Address - Country:US
Mailing Address - Phone:860-676-8115
Mailing Address - Fax:860-677-6015
Practice Address - Street 1:40 DALE RD
Practice Address - Street 2:STE 104
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3692
Practice Address - Country:US
Practice Address - Phone:860-676-8115
Practice Address - Fax:860-677-6015
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0236742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0V0022OtherHEALTHNET
CT001236744Medicaid
CT010023674CT02OtherANTHEM BCBS
B38287Medicare UPIN
CT0V0022OtherHEALTHNET