=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346881125
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA SAKAL CCP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2019
-----------------------------------------------------
Last Update Date | 10/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 114 WOODLAND ST
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06105-1208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-714-9720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 GRANT DR
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17406-2361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-458-5523
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 242T00000X
-----------------------------------------------------
Taxonomy Name | Perfusionist
-----------------------------------------------------
License Number | 149
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------