Healthcare Provider Details

I. General information

NPI: 1427230614
Provider Name (Legal Business Name): SHARON J ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 GRAND AVE
NEW HAVEN CT
06513-3733
US

IV. Provider business mailing address

374 GRAND AVE
NEW HAVEN CT
06513-3733
US

V. Phone/Fax

Practice location:
  • Phone: 203-777-7411
  • Fax: 203-777-8506
Mailing address:
  • Phone: 203-777-7411
  • Fax: 203-777-8506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number049201
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: