Provider Demographics
NPI:1134263718
Name:SANDT, ANNETTE C (DC)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:C
Last Name:SANDT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 PINEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3369
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1077 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4622
Practice Address - Country:US
Practice Address - Phone:203-929-5700
Practice Address - Fax:203-929-5600
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT714754OtherCONNECTICARE ID
CT050001334CT04OtherANTHEM BCBS ID
CTP2531544OtherOXFORD ID
CT2591871OtherAETNA ID
CT2V0230OtherHEALTHNET & PHS