Provider Demographics
NPI:1407833106
Name:SANDOVAL, SYBIL LEE (MD)
Entity Type:Individual
Prefix:
First Name:SYBIL
Middle Name:LEE
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:30 JORDAN LN
Mailing Address - Street 2:PRIME HEALTHCARE
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1278
Mailing Address - Country:US
Mailing Address - Phone:860-263-0253
Mailing Address - Fax:860-263-0262
Practice Address - Street 1:44 DALE RD
Practice Address - Street 2:PRIME HEALTHCARE
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3612
Practice Address - Country:US
Practice Address - Phone:860-674-8830
Practice Address - Fax:860-674-8984
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT032256207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT032256OtherMEDICAL LICENSE
CT010032256CT03OtherBCBS
CTB53183263OtherDEA
CT010032256CT03OtherBCBS
CTB53183263OtherDEA