Provider Demographics
NPI:1942919709
Name:STEELE, FABIAN
Entity Type:Individual
Prefix:
First Name:FABIAN
Middle Name:
Last Name:STEELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 MARLBORO ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-3126
Mailing Address - Country:US
Mailing Address - Phone:800-593-5669
Mailing Address - Fax:
Practice Address - Street 1:64 MARLBORO ST
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-3126
Practice Address - Country:US
Practice Address - Phone:800-593-5669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA.0001544364SH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT274-06-5205OtherN/P
CT274065205Medicaid