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1831215482 NPI number — SARAH SANDBERG PA

NPI Number: 1831215482
Health Care Provider/Practitioner: SARAH SANDBERG PA

Information about “1831215482” NPI (SARAH SANDBERG PA) exists in 1831215482 in HTML format HTML  |  1831215482 in plain Text format TXT  |  1831215482 in PDF (Portable Document Format) PDF  |  1831215482 in an XML format XML  formats.

NPI Number : 1831215482 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1831215482",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SANDBERG",
    "FirstName": "SARAH",
    "MiddleName": null,
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "PA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GROSE",
    "OtherFirstName": "SARAH ELIZABETH",
    "OtherMiddleName": "HOUSTON",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "PAC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "128 S HIGHLAND ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WEST HARTFORD",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06119-1833",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "860-508-5492",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "41 BREWSTER RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BRISTOL",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06011-0977",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "203-585-3000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/22/2007",
    "LastUpdateDate": "03/03/2010",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363AS0400X",
        "TaxonomyName": "Surgical Physician Assistant",
        "LicenseNumber": "1838",
        "LicenseNumberStateCode": "CT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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