Provider Demographics
NPI:1710154000
Name:SANDERS, AMY ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELAINE
Last Name:SANDERS
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 1:1260 SILAS DEANE HWY
Mailing Address - Street 2:HARTFORD HOSPITAL NEUROLOGY DEPT
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4362
Mailing Address - Country:US
Mailing Address - Phone:860-696-2820
Mailing Address - Fax:
Practice Address - Street 1:1260 SILAS DEANE HWY
Practice Address - Street 2:HARTFORD HOSPITAL NEUROLOGY DEPT
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4362
Practice Address - Country:US
Practice Address - Phone:860-696-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT621872084N0400X
NY2436082084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02986309Medicaid
CT008085144Medicaid