Healthcare Provider Details

I. General information

NPI: 1891059655
Provider Name (Legal Business Name): REBECCA SWEENEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 NEWFIELD AVE
STAMFORD CT
06905-1409
US

IV. Provider business mailing address

1180 NEWFIELD AVE
STAMFORD CT
06905-1409
US

V. Phone/Fax

Practice location:
  • Phone: 314-888-5233
  • Fax: 203-590-8644
Mailing address:
  • Phone: 314-888-5233
  • Fax: 203-590-8644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number262034
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: