Healthcare Provider Details

I. General information

NPI: 1265862098
Provider Name (Legal Business Name): MRS. JILLIAN SACCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLIAN BALISCIANO

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 CHAPEL ST
NEW HAVEN CT
06511-4411
US

IV. Provider business mailing address

148 MILL POND HEIGHTS RD
EAST HAVEN CT
06513-1334
US

V. Phone/Fax

Practice location:
  • Phone: 203-865-3852
  • Fax:
Mailing address:
  • Phone: 203-824-2081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5621
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: