Provider Demographics
NPI:1366441628
Name:BARNOSKY, SANDRA A (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:A
Last Name:BARNOSKY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-1760
Mailing Address - Country:US
Mailing Address - Phone:860-679-2223
Mailing Address - Fax:860-679-1233
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:MC1705
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-0001
Practice Address - Country:US
Practice Address - Phone:860-679-2223
Practice Address - Fax:860-679-1233
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001732363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400017969OtherMEDICARE PTAN FOR UMG
CT004225589Medicaid
CTD400017969OtherMEDICARE PTAN FOR UMG
CTS64572Medicare UPIN