Healthcare Provider Details

I. General information

NPI: 1619285426
Provider Name (Legal Business Name): SABITHA VIGNESH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 VERNON AVE UNIT-213
VERNON CT
06066-4348
US

IV. Provider business mailing address

205 VERNON AVE UNIT-213
VERNON CT
06066-4348
US

V. Phone/Fax

Practice location:
  • Phone: 408-391-4293
  • Fax:
Mailing address:
  • Phone: 408-391-4293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number052463
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: