Provider Demographics
NPI:1689948986
Name:ARIELLA, RAYA (FNP)
Entity Type:Individual
Prefix:
First Name:RAYA
Middle Name:
Last Name:ARIELLA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 S CANAAN RD
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06018-2544
Mailing Address - Country:US
Mailing Address - Phone:860-824-1397
Mailing Address - Fax:
Practice Address - Street 1:187 S CANAAN RD
Practice Address - Street 2:
Practice Address - City:CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06018-2544
Practice Address - Country:US
Practice Address - Phone:860-824-1397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-04
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33 340065363LF0000X
MECNP121049363LF0000X
CT6579363LF0000X
MARN2270209363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2270209OtherMASSACHUSETTS NP LICENSE
CT6579OtherAPRN LICENSE