Provider Demographics
NPI:1447779582
Name:CONNECTICUT AMBULATORY ANESTHESIA, PLLC
Entity Type:Organization
Organization Name:CONNECTICUT AMBULATORY ANESTHESIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SHEETZ
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:203-509-3966
Mailing Address - Street 1:58 BITTERSWEET LN
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-1202
Mailing Address - Country:US
Mailing Address - Phone:203-606-5162
Mailing Address - Fax:
Practice Address - Street 1:863 N MAIN STREET EXT STE 301
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2434
Practice Address - Country:US
Practice Address - Phone:203-269-0885
Practice Address - Fax:203-269-3496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-10
Last Update Date:2017-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty