Healthcare Provider Details

I. General information

NPI: 1285998740
Provider Name (Legal Business Name): SARAH A JILLANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 E KINGS CANYON RD
FRESNO CA
93702-3604
US

IV. Provider business mailing address

20 YORK ST YNHH DEPARTMENT OF PSYCHIATRY
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 559-892-1128
  • Fax:
Mailing address:
  • Phone: 203-688-9503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number054590
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA133322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: