Provider Demographics
NPI:1902998263
Name:RABIS, SANDRA J (APRN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:RABIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WHITING ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3184
Mailing Address - Country:US
Mailing Address - Phone:860-223-2778
Mailing Address - Fax:
Practice Address - Street 1:79 MILL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4468
Practice Address - Country:US
Practice Address - Phone:860-798-0148
Practice Address - Fax:860-345-7527
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002361363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004251550Medicaid
CT004251550Medicaid
CTP20408Medicare UPIN