Provider Demographics
NPI:1407233547
Name:IDREES, SANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANA
Middle Name:
Last Name:IDREES
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 1:31 PINE HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-6013
Mailing Address - Country:US
Mailing Address - Phone:860-378-9290
Mailing Address - Fax:
Practice Address - Street 1:98 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489
Practice Address - Country:US
Practice Address - Phone:860-426-2851
Practice Address - Fax:860-426-0458
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT61908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine