Provider Demographics
NPI:1669696803
Name:ANDRUSKIWEC, SHARON PATRICIA (PT CHT)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:PATRICIA
Last Name:ANDRUSKIWEC
Suffix:
Gender:F
Credentials:PT CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-8235
Mailing Address - Country:US
Mailing Address - Phone:203-283-1113
Mailing Address - Fax:
Practice Address - Street 1:75 KINGS HIGHWAY CUTOFF
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5340
Practice Address - Country:US
Practice Address - Phone:203-337-2677
Practice Address - Fax:203-337-2675
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT26212251H1200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004143418Medicaid
076557Medicare ID - Type UnspecifiedADVANTAGE HEALTHSOUTH