MEDICARE: MRS. SANDRA NTREH APRN, PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	6788	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073065603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA NTREH APRN, PMHNP

Provider Business Mailing Address
First Line	:	PO BOX 7720
Second Line	:	CREDENTIALING SPECIALIST
City	:	NEW HAVEN
State	:	CT
Zip	:	06519
Country	:	US
Telephone Number	:	203-503-3174
Fax Number	:	203-503-6515

Provider Business Practice Location Address
First Line	:	115 ARDALE ST
Second Line	:
City	:	WEST HAVEN
State	:	CT
Zip	:	06516-1834
Country	:	US
Telephone Number	:	860-796-5683
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2016
Last Update Date	:	10/04/2019

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