Provider Demographics
NPI:1528181716
Name:KANDRO, SHARON A (APRN)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:A
Last Name:KANDRO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-2212
Mailing Address - Country:US
Mailing Address - Phone:860-679-7503
Mailing Address - Fax:860-679-1610
Practice Address - Street 1:1 ROYCE CIR
Practice Address - Street 2:SUITE 104
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268-2260
Practice Address - Country:US
Practice Address - Phone:860-487-9200
Practice Address - Fax:860-487-9222
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT002294363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1528181716Medicaid