Provider Demographics
NPI:1669451530
Name:ESCALERA, SANDRA I (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:I
Last Name:ESCALERA
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:PO BOX 206084
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-6084
Mailing Address - Country:US
Mailing Address - Phone:203-785-4649
Mailing Address - Fax:203-737-1384
Practice Address - Street 1:1 PARK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06504-8901
Practice Address - Country:US
Practice Address - Phone:203-785-4649
Practice Address - Fax:203-737-1384
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0355792080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001355793Medicaid
H05206Medicare UPIN
CT370001258Medicare ID - Type Unspecified