Provider Demographics
NPI:1528402963
Name:WASTERLAIN, AMY SARAH (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:SARAH
Last Name:WASTERLAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:410 SAYBROOK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4780
Mailing Address - Country:US
Mailing Address - Phone:860-685-8940
Mailing Address - Fax:860-685-8944
Practice Address - Street 1:410 SAYBROOK RD STE 100
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4780
Practice Address - Country:US
Practice Address - Phone:860-685-8940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-27
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT62336207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery