Provider Demographics
NPI:1831215482
Name:SANDBERG, SARAH (PA)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:
Last Name:SANDBERG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:SARAH ELIZABETH
Other - Middle Name:HOUSTON
Other - Last Name:GROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:128 S HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1833
Mailing Address - Country:US
Mailing Address - Phone:860-508-5492
Mailing Address - Fax:
Practice Address - Street 1:41 BREWSTER RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06011-0977
Practice Address - Country:US
Practice Address - Phone:203-585-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1838363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical