Healthcare Provider Details

I. General information

NPI: 1669451530
Provider Name (Legal Business Name): SANDRA I ESCALERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARK ST
NEW HAVEN CT
06504-8901
US

IV. Provider business mailing address

PO BOX 206084
NEW HAVEN CT
06520-6084
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4649
  • Fax: 203-737-1384
Mailing address:
  • Phone: 203-785-4649
  • Fax: 203-737-1384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number035579
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: