Provider Demographics
NPI:1013901453
Name:TORRE, STEPHENIE D (PAC)
Entity Type:Individual
Prefix:
First Name:STEPHENIE
Middle Name:D
Last Name:TORRE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1351
Mailing Address - Country:US
Mailing Address - Phone:203-261-3980
Mailing Address - Fax:203-261-2747
Practice Address - Street 1:15 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1351
Practice Address - Country:US
Practice Address - Phone:203-261-3980
Practice Address - Fax:203-261-2747
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001457363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q09030Medicare UPIN
970001556Medicare ID - Type Unspecified