Provider Demographics
NPI:1962431346
Name:CORBIN, SANDRA LYNN (ARNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:CORBIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 YORK ST
Mailing Address - Street 2:SMILOW CANCER HOSPITAL
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-200-3221
Mailing Address - Fax:203-200-1517
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:SMILOW CANCER HOSPITAL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-200-3221
Practice Address - Fax:203-200-1517
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR194775363L00000X
VA0024137956364SX0200X
WV56283363L00000X
OHCOA.05879-NP363L00000X
CT171733363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000493421OtherANTHEM BCBS
P00321795OtherRR MEDICARE
WV3810005675Medicaid
MD556625800Medicaid
1962431346OtherNPI
001873033OtherMOUNTAIN STATE BCBS
WV3810005675Medicaid
OHP54630Medicare UPIN
MD556625800Medicaid