Provider Demographics
NPI:1255344198
Name:MINI, SANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:MINI
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 1:7 RIVERSVILLE RD.
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831
Mailing Address - Country:US
Mailing Address - Phone:203-531-1808
Mailing Address - Fax:203-531-8326
Practice Address - Street 1:7 RIVERSVILLE RD.
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831
Practice Address - Country:US
Practice Address - Phone:203-531-1808
Practice Address - Fax:203-531-8326
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044495207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010044495CT01OtherANTHEM BLUE CROSS
CT605554OtherCONNECTICARE
CTP3778544OtherOXFORD
1398696OtherAETNA
CT001444950Medicaid
CT1603928OtherCIGNA
CT2V8895OtherHEALTHNET
CT010044495CT01OtherANTHEM BLUE CROSS
I65829Medicare UPIN