MEDICARE: EDLEEN DE JESUS-SANCHEZ PSYD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1962365510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDLEEN DE JESUS-SANCHEZ PSYD

Provider Business Mailing Address
First Line	:	200 RETREAT AVE
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06106-3310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 RETREAT AVE
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06106-3310
Country	:	US
Telephone Number	:	806-545-7755
Fax Number	:

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

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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