Healthcare Provider Details

I. General information

NPI: 1063717403
Provider Name (Legal Business Name): SADIE C CHANG REGISTER NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2011
Last Update Date: 01/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 OLD NORTH STAMFORD RD
STAMFORD CT
06905-3961
US

IV. Provider business mailing address

22 OLD NORTH STAMFORD RD
STAMFORD CT
06905-3961
US

V. Phone/Fax

Practice location:
  • Phone: 646-662-7601
  • Fax:
Mailing address:
  • Phone: 646-662-7601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number302363-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR36052
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: