Provider Demographics
NPI:1093924417
Name:DHANJAL, SANDHYA (MD)
Entity type:Individual
Prefix:
First Name:SANDHYA
Middle Name:
Last Name:DHANJAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 POST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6232
Mailing Address - Country:US
Mailing Address - Phone:203-255-4545
Mailing Address - Fax:203-254-1191
Practice Address - Street 1:425 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6232
Practice Address - Country:US
Practice Address - Phone:203-255-4545
Practice Address - Fax:203-254-1191
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045127207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001451278Medicaid
CT001451278Medicaid
PENDINGMedicare UPIN