Healthcare Provider Details

I. General information

NPI: 1982630067
Provider Name (Legal Business Name): SANATH NALLAINATHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2590 MAIN ST
STRATFORD CT
06615-5838
US

IV. Provider business mailing address

CAYER CIRCLE
HUNTINGTON CT
06484
US

V. Phone/Fax

Practice location:
  • Phone: 203-377-5988
  • Fax: 203-380-0531
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number019702
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: