Individual provider Active NPI

Stephanie Kyc

  • Pediatrics Physician
  • New Haven, CT
National Provider Identifier
1053754705
Registry record updated Aug 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
72133 Issued in CT
Practice address
1 Park St
New Haven, CT 06504-8901
Phone
(203) 688-2320
NPI assigned
Apr 12, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 298258 NY
Neonatal-Perinatal Medicine Physician 2080N0001X 298258 NY
Pediatrics Physician 208000000X 72133 CT Primary

Addresses

Primary practice location

1 Park St
New Haven, CT 06504-8901

Mailing address

1 Park St
New Haven, CT 06504-8901

Other practice location 1

101 Nicolls Rd # T11-060
Stony Brook, NY 11794
Phone (631) 444-7653

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221108001915 CT Practitioner - Pediatric Medicine 0941594733 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
72133CTMDPediatrics Physician
298258NYMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Yale University CurrentSince Oct 13, 2022 Accepting new patients
Yale University Pediatrics CurrentSince Oct 13, 2022 Accepting new patients
University Hospital at Stony Brook Current Accepting new patients

Locations

800 Howard Ave
New Haven, CT 06519
Phone (203) 785-2140

50 Division St
New Haven, CT 06511
Phone (203) 785-2140

20 York St
North Haven, CT 06510
Phone (203) 688-2433

1 Park St
North Haven, CT 06504
Phone (203) 785-4643

101 Nicolls Rd
#T11060
Stony Brook, NY 11794
Phone (631) 444-7653

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

Interoperability endpoints

  • Direct secure messaging: stephanie.kyc@direct.stonybrookmedicine.edu
  • Direct secure messaging: skyc337453@direct.ynhh.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660780800000",
    "number": "1053754705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PARK ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065048901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PARK ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065048901",
            "telephone_number": "203-688-2320"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Nicolls Rd # T11-060",
            "address_purpose": "LOCATION",
            "city": "Stony Brook",
            "state": "NY",
            "postal_code": "11794",
            "country_code": "US",
            "telephone_number": "631-444-7653",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KYC",
        "first_name": "STEPHANIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-12",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "298258",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "NY",
            "license": "298258",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "72133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.