Healthcare Provider Details

I. General information

NPI: 1598654683
Provider Name (Legal Business Name): SARA ROBERGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA BRAZEL

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 08/29/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

99 E RIVER DR FL 5
EAST HARTFORD CT
06108-7301
US

V. Phone/Fax

Practice location:
  • Phone: 860-282-0833
  • Fax:
Mailing address:
  • Phone: 860-282-0833
  • Fax: 866-623-8110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number15087
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10.127881
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: