Provider Demographics
NPI:1407103997
Name:SACRAMENTO FERREIRA, ISIS (MD)
Entity Type:Individual
Prefix:MISS
First Name:ISIS
Middle Name:
Last Name:SACRAMENTO FERREIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8D CANAL CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3747
Mailing Address - Country:US
Mailing Address - Phone:860-674-9686
Mailing Address - Fax:860-674-9954
Practice Address - Street 1:8D CANAL CT
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001
Practice Address - Country:US
Practice Address - Phone:860-674-9686
Practice Address - Fax:860-674-9954
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT60384207R00000X
MDD79058207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD095851400Medicaid
MDE6360022OtherCAREFIRST BS
MD423512ZEHPMedicare PIN