MEDICARE: MS. SARAH A DONAHUE APRN

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	363LP0200X	Pediatric Nurse Practitioner	002544	CT

General Provider Information

NPI Number	:	1528055894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH A DONAHUE APRN

Provider Business Mailing Address
First Line	:	3180 MAIN ST
Second Line	:	SUITE G-1
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-4237
Country	:	US
Telephone Number	:	203-371-7111
Fax Number	:	203-372-5636

Provider Business Practice Location Address
First Line	:	3180 MAIN ST
Second Line	:	SUITE G-1
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-4237
Country	:	US
Telephone Number	:	203-371-7111
Fax Number	:	203-372-5636

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	07/27/2010

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