Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 258865 | MA |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 56050 | CT |
NPI | 1134449697 |
---|---|
Provider Name | Stephanie L Bakaysa |
First Address | Hartford, CT 06102-5037 |
Second Address | Hartford, CT 06106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2010 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1134449697 | (05) | CT |