Healthcare Provider Details

I. General information

NPI: 1669577391
Provider Name (Legal Business Name): SARAH ELIZABETH SANTISI RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 EAST AVE SUITE 307
NORWALK CT
06897
US

IV. Provider business mailing address

83 EAST AVE SUITE 307
NORWALK CT
06897
US

V. Phone/Fax

Practice location:
  • Phone: 203-866-2212
  • Fax: 206-866-2207
Mailing address:
  • Phone: 203-866-2212
  • Fax: 206-866-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000763
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: