Healthcare Provider Details

I. General information

NPI: 1104370030
Provider Name (Legal Business Name): SARA KHALIFE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 COLUMBUS AVE PEDICATRICS
NEW HAVEN CT
06519-1233
US

IV. Provider business mailing address

400 COLUMBUS AVE CREDENTIALING SPECIALIST
NEW HAVEN CT
06519-1233
US

V. Phone/Fax

Practice location:
  • Phone: 203-503-3000
  • Fax: 203-503-3224
Mailing address:
  • Phone: 203-503-3174
  • Fax: 203-503-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberLP03805
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number68700
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: