Healthcare Provider Details

I. General information

NPI: 1932101854
Provider Name (Legal Business Name): SANDRA PECCERILLO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 BARNES RD
WALLINGFORD CT
06492-6012
US

IV. Provider business mailing address

231 COURT ST
WEST HAVEN CT
06516-4932
US

V. Phone/Fax

Practice location:
  • Phone: 203-294-6328
  • Fax: 203-294-6346
Mailing address:
  • Phone: 120-640-8551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number001730
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number001730
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1730
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: