Provider Demographics
NPI:1679506539
Name:LACHOWICZ, SABRINA MICHELLE (PA)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:MICHELLE
Last Name:LACHOWICZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 MAIN ST
Mailing Address - Street 2:STE 1
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2260
Mailing Address - Country:US
Mailing Address - Phone:336-993-8333
Mailing Address - Fax:336-993-5144
Practice Address - Street 1:85 SEYMOUR ST STE 500
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5524
Practice Address - Country:US
Practice Address - Phone:605-459-4408
Practice Address - Fax:860-545-9445
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3499363A00000X
NC0010-00150363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC001000150OtherMEDICAL BOARD LICENSE
CT003499OtherMEDICAL LICENSE
NC1066715OtherPA CERTIFICATE