Provider Demographics
NPI:1003965450
Name:BERARDY, SANDRA (AP RN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:BERARDY
Suffix:
Gender:F
Credentials:AP RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BALDWIN CT
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-1833
Mailing Address - Country:US
Mailing Address - Phone:860-848-7309
Mailing Address - Fax:860-312-8036
Practice Address - Street 1:75 ROUTE 2
Practice Address - Street 2:MASHANTUCKET PEQUOT INDIAN HEALTH SERVICES
Practice Address - City:LEDYARD
Practice Address - State:CT
Practice Address - Zip Code:06339
Practice Address - Country:US
Practice Address - Phone:860-312-8000
Practice Address - Fax:860-312-8036
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001034363L00000X, 364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001034OtherAPRN