Healthcare Provider Details

I. General information

NPI: 1033859657
Provider Name (Legal Business Name): SAMANTHA SUTCLIFFE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 WHITNEY AVE
NEW HAVEN CT
06511-2348
US

IV. Provider business mailing address

345 WHITNEY AVE
NEW HAVEN CT
06511-2348
US

V. Phone/Fax

Practice location:
  • Phone: 203-503-0450
  • Fax:
Mailing address:
  • Phone: 203-503-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCNM00198
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: