Provider Demographics
NPI:1659525095
Name:SAHADEVAN FOSSLAND, VICTORIA INDIRA (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:INDIRA
Last Name:SAHADEVAN FOSSLAND
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 1:50 HOSPITAL HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:CT
Mailing Address - Zip Code:06069-2096
Mailing Address - Country:US
Mailing Address - Phone:860-364-4511
Mailing Address - Fax:
Practice Address - Street 1:50 HOSPITAL HILL RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:CT
Practice Address - Zip Code:06069-2096
Practice Address - Country:US
Practice Address - Phone:860-364-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT049590208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery