Healthcare Provider Details

I. General information

NPI: 1043647845
Provider Name (Legal Business Name): SARA L LANDINO MAHON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2013
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 MAIN ST
BRIDGEPORT CT
06606-4201
US

IV. Provider business mailing address

40 COVENTRY CIR
NORTH HAVEN CT
06473-1128
US

V. Phone/Fax

Practice location:
  • Phone: 203-576-6000
  • Fax:
Mailing address:
  • Phone: 203-605-4035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number082096
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number93244
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: