Healthcare Provider Details

I. General information

NPI: 1376526830
Provider Name (Legal Business Name): SHERIDAN HEALTHCARE OF CONNECTICUT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 POMFRET ST
PUTNAM CT
06260-1836
US

IV. Provider business mailing address

PO BOX 744576
ATLANTA GA
30374-4576
US

V. Phone/Fax

Practice location:
  • Phone: 860-928-6541
  • Fax:
Mailing address:
  • Phone: 954-838-2371
  • Fax: 913-242-6850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN KONDAS
Title or Position: OFFICER
Credential:
Phone: 954-838-2371