Provider Demographics
NPI:1114100104
Name:PELS, SALLEY GIBNEY (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLEY
Middle Name:GIBNEY
Last Name:PELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SALLEY
Other - Middle Name:ANNE
Other - Last Name:GIBNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:333 CEDAR ST
Mailing Address - Street 2:LMP 2073, PO BOX 208064
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3206
Mailing Address - Country:US
Mailing Address - Phone:203-785-4640
Mailing Address - Fax:203-737-2228
Practice Address - Street 1:333 CEDAR ST
Practice Address - Street 2:LMP 2073
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3206
Practice Address - Country:US
Practice Address - Phone:203-785-4640
Practice Address - Fax:203-737-2228
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0477792080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology