SANDRA DAWN FOMENKO (NPI# 1437435419) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437435419 |
| Entity Type | Individual |
| Full Name | SANDRA DAWN FOMENKO |
| Credential | MSN, APRN, PNP-BC |
| Practice Address |
635 Main St Middletown CT 06457-2718 |
| Mailing Address |
575 Main St Fl 2 Attn: Credentialing Dpt Middletown CT 06457-2845 |
| Practice Telephone | 8603476971 |
| Practice Fax Number | 8603437379 |
| Mailing Telephone | 8603476971 |
| Enumeration Date | 2011-10-22 |
| Last Update Date | 2012-02-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
004756 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 004236346 | 05 |
| Street Address |
635 MAIN ST |
| City | MIDDLETOWN |
| State | CT |
| Zip Code | 06457-2718 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144226390 | R. Timothy Kearney | Psychologist | 635 Main St, Middletown, CT 06457-2718 | 2005-06-22 |
| 1750842555 | Shannon Katherine Rouse | Marriage & Family Therapist | 635 Main St, Middletown, CT 06457-2718 | 2019-03-26 |
| 1316489313 | Maria Teresa Machado | Dental Hygienist | 635 Main St, Middletown, CT 06457-2718 | 2016-11-08 |
| 1528518693 | Tara Nicole Tremblay | Dental Hygienist | 635 Main St, Attn: Credentialing Dpt, Middletown, CT 06457-2718 | 2016-10-12 |
| 1982960431 | Mandy Sullivan | Counselor | 635 Main St, Middletown, CT 06457-2718 | 2012-04-10 |
| 1083980957 | Christine Foley | Psychologist | 635 Main St, Middletown, CT 06457-2718 | 2012-03-26 |
| 1770814105 | Luz Hago | Dietitian, Registered | 635 Main St, Middletown, CT 06457-2718 | 2010-01-25 |
| 1598092561 | Julie B Nash | Psychologist | 635 Main St, Middletown, CT 06457-2718 | 2009-11-11 |
| 1073761821 | Nancy Trouern Trend | Registered Nurse | 635 Main St, Middletown, CT 06457-2718 | 2008-09-05 |
| 1447413646 | Kimberly Fournier | Social Worker | 635 Main St, Middletown, CT 06457-2718 | 2008-07-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699391961 | Meghan Harrington | Behavior Technician | 101 Centerpoint Drive #243, Middletown, CT 06457 | 2020-06-22 |
| 1427619626 | Collaborative Aba Services, LLC | Behavioral Analyst | 515 Centerpoint Drive, Suite 205, Middletown, CT 06457 | 2019-06-27 |
| 1376100339 | Kimberly Tynik | Pharmacist | 451 Fowler Ave, Middletown, CT 06457 | 2019-05-24 |
| 1184101263 | Tabrez Adil | Dentist | 675 Main St., Middletown, CT 06457 | 2018-07-23 |
| 1326535337 | Rehan Khan | Non-emergency Medical Transport (VAN) | 765 Country Club Rd, Middletown, CT 06457 | 2018-04-16 |
| 1366950206 | State of Connecticut | Psychiatric Hospital | 70 O'brien Drive, Middletown, CT 06457 | 2018-01-12 |
| 1902324536 | Cynthia Tine | Physical Therapy Assistant | 628 Congdon Street, Middletown, CT 06457 | 2017-09-04 |
| 1619494390 | Nathan Douglas Roy | Specialist/Technologist | 431 Briarwood Lane, Middletown, CT 06457 | 2017-08-24 |
| 1598286502 | Rachel Hoffman Whelen | Registered Nurse | 420 Saybrook Road, Suite A, Middletown, CT 06457 | 2017-06-29 |
| 1003358326 | Rebecca Rotondo | Social Worker | 230 Main Street Extension, Act Team, Gilead Community Services, Middletown, CT 06457 | 2016-11-17 |
| Find all providers in zip 06457 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144820077 | Karen Wood | Nurse Practitioner | 1272 W Main Rd Bldg 3, Middletown, RI 02842-6335 | 2020-10-29 |
| 1194140400 | Lorna A Divino | Nurse Practitioner | 200 Cleaver Farms Rd Ste 201, Middletown, DE 19709 | 2014-02-24 |
| 1891125654 | Talena Ullery | Nurse Practitioner | 200 Hollytree Dr, Middletown, OH 45044-3340 | 2013-11-14 |
| 1821345018 | Winifred S. O. Mellinger | Nurse Practitioner | 122 Silver Lake Road, Middletown School Based Health Center, Middletown, DE 19709 | 2012-08-07 |
| 1497944425 | Kerry Rose Stephenson | Nurse Practitioner | 575 Main St Fl 2, Attn: Credentialing Dpt, Middletown, CT 06457-2845 | 2007-10-16 |
| 1942812623 | Priyanka Tadepalli | Nurse Practitioner | 707 E Main St, Middletown, NY 10940-2650 | 2020-08-23 |
| 1750856274 | Caroline Elizabeth Stockert | Nurse Practitioner | 300 Crystal Run Rd, Middletown, NY 10941-4069 | 2018-10-11 |
| 1669955910 | Lauren Michelle Grant | Nurse Practitioner | 333 Conover Dr Ste B, Middletown, OH 45005-1900 | 2018-09-12 |
| 1104112531 | Sandra Louise Bailey | Nurse Practitioner | 331 N Breiel Blvd, Middletown, OH 45042-3868 | 2011-06-23 |
| 1528249331 | Jennifer Darcy Hill | Nurse Practitioner | 635 Main St, Middletown, CT 06457-2718 | 2007-11-20 |
| Find all providers in MIDDLETOWN | ||||
| City | MIDDLETOWN |
| Zip Code | 06457 |
Please comment or provide details below to improve the information on SANDRA DAWN FOMENKO.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.