Provider Demographics
NPI:1194790329
Name:ALLISON, SANDRA L (PA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:ALLISON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3222
Mailing Address - Country:US
Mailing Address - Phone:203-288-9650
Mailing Address - Fax:203-288-9670
Practice Address - Street 1:2440 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3222
Practice Address - Country:US
Practice Address - Phone:203-288-9650
Practice Address - Fax:203-288-9670
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000152363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000152OtherCONNECTICARE
CT290000152CT04OtherANTHEM BC BS CT
CT970018978OtherRAILROAD MEDICARE
CT0Q2941OtherHEALTH NET
CT0Q2941OtherHEALTH NET
CT000152OtherCONNECTICARE