Provider Demographics
NPI:1427920024
Name:SAREFO, PENNY I (HCA 0002082)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:SAREFO
Suffix:I
Gender:F
Credentials:HCA 0002082
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 DALEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6132
Mailing Address - Country:US
Mailing Address - Phone:203-768-7706
Mailing Address - Fax:
Practice Address - Street 1:99 DALEWOOD AVE # 99
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6132
Practice Address - Country:US
Practice Address - Phone:203-768-7706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA0002082374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide