Healthcare Provider Details

I. General information

NPI: 1902803299
Provider Name (Legal Business Name): JACQUELINE MS SLOAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE M SHAFTO

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 HOPMEADOW STREET
WEATOGUE CT
06089
US

IV. Provider business mailing address

46 GREAT POND RD
SIMSBURY CT
06070-1904
US

V. Phone/Fax

Practice location:
  • Phone: 860-658-0465
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number045826
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: