Healthcare Provider Details

I. General information

NPI: 1003965450
Provider Name (Legal Business Name): SANDRA BERARDY AP RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ROUTE 2 MASHANTUCKET PEQUOT INDIAN HEALTH SERVICES
LEDYARD CT
06339
US

IV. Provider business mailing address

24 BALDWIN CT
UNCASVILLE CT
06382-1833
US

V. Phone/Fax

Practice location:
  • Phone: 860-312-8000
  • Fax: 860-312-8036
Mailing address:
  • Phone: 860-848-7309
  • Fax: 860-312-8036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number001034
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number001034
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: