Fomenko, Sandra Dawn

Fomenko, Sandra Dawn is an individual health care provider with primary practice located at 1952 Whitney Ave Ste 3 , Hamden CT 06517-1209. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Physician Assistants & Advanced Practice Nursing Providers / Adult Health is her primary health care specialty. Fomenko, Sandra Dawn can be contacted via phone (203) 848-1803.

Contact Information

Primary practice address
1952 Whitney Ave Ste 3 Hamden CT 06517-1209
Phone: (203) 848-1803
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 004756 Connecticut
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 004756 Connecticut

Profile Details

NPI number 1437435419
LBN Legal business name Fomenko, Sandra Dawn
Credentials MSN, AGPCNP-BC, CPNP
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 22nd, 2011
Last updated Mar 29th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1437435419 NPPES
Connecticut MEDICAID 004236346

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