Healthcare Provider Details

I. General information

NPI: 1841525482
Provider Name (Legal Business Name): SARAH F PRYOR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH F GOODSTEIN PA

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST CB 2041
NEW HAVEN CT
06510
US

IV. Provider business mailing address

20 YORK ST CB 2041
NEW HAVEN CT
06510
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-4748
  • Fax: 203-688-4740
Mailing address:
  • Phone: 203-688-4748
  • Fax: 203-688-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2335
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: