Healthcare Provider Details

I. General information

NPI: 1962263152
Provider Name (Legal Business Name): SARA JILLIAN RIOUX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 MOUNT CARMEL AVE
HAMDEN CT
06518-1961
US

IV. Provider business mailing address

105 HENDERSON ST
BRISTOL CT
06010-3633
US

V. Phone/Fax

Practice location:
  • Phone: 203-707-0114
  • Fax:
Mailing address:
  • Phone: 203-707-0114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number137829
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: