MEDICARE: KATELYN SANDERS

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	374J00000X	Doula

General Provider Information

NPI Number	:	1972047322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN SANDERS

Provider Business Mailing Address
First Line	:	72 BLYDENBURG AVE
Second Line	:
City	:	NEW LONDON
State	:	CT
Zip	:	06320-4808
Country	:	US
Telephone Number	:	860-214-0068
Fax Number	:

Provider Business Practice Location Address
First Line	:	72 BLYDENBURG AVE
Second Line	:
City	:	NEW LONDON
State	:	CT
Zip	:	06320-4808
Country	:	US
Telephone Number	:	860-214-0068
Fax Number	:

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

Provider Enumeration Date	:	12/05/2016
Last Update Date	:	12/05/2016

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Directions to “ KATELYN SANDERS ” Practice Location

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