Provider Demographics
NPI:1235285115
Name:GUILLOW, SANDRA (MAC, LICAC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:GUILLOW
Suffix:
Gender:F
Credentials:MAC, LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BIRCH TER
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CT
Mailing Address - Zip Code:06370-1705
Mailing Address - Country:US
Mailing Address - Phone:860-303-3717
Mailing Address - Fax:860-444-7917
Practice Address - Street 1:10 BIRCH TER
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CT
Practice Address - Zip Code:06370-1705
Practice Address - Country:US
Practice Address - Phone:860-303-3717
Practice Address - Fax:860-444-7917
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000319171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061533801OtherLANDMARK HEALTHCARE ID