Provider Demographics
NPI:1063717403
Name:CHANG, SADIE C (REGISTER NURSE)
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:C
Last Name:CHANG
Suffix:
Gender:F
Credentials:REGISTER NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 OLD NORTH STAMFORD RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-3961
Mailing Address - Country:US
Mailing Address - Phone:646-662-7601
Mailing Address - Fax:
Practice Address - Street 1:22 OLD NORTH STAMFORD RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-3961
Practice Address - Country:US
Practice Address - Phone:646-662-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-16
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302363-1163W00000X
CTR36052163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse