Provider Demographics
NPI:1134376429
Name:BRIAN, STEPHANIE MICHELE
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MICHELE
Last Name:BRIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:MICHELE
Other - Last Name:BRIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:33 COSEY BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-4905
Mailing Address - Country:US
Mailing Address - Phone:203-468-4718
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520
Practice Address - Country:US
Practice Address - Phone:203-688-2363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046890207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology