Sandra Paola Jackson, NURSE PRACTITIONER

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

12560 Issued in CT

Practice address

10 Mott Ave Ste 2a
Norwalk, CT 06850-3320

Phone

(203) 855-7551

NPI assigned

Dec 19, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Center for Pediatric Medicine

  • Pediatrics Physician
  • Danbury, CT
  • NPI 1861530750
  NPD (past)
• T.L.C. Pediatrics, LLC

  • Pediatrics Physician
  • Norwalk, CT
  • NPI 1801073176
  NPD (past)
• The Center for Advanced Pediatrics, P.C

  • Pediatrics Physician
  • Norwalk, CT
  • NPI 1750305017
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1702944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703030400000",
    "number": "1205604246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 MOTT AVE STE 2A",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068503320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 MOTT AVE STE 2A",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068503320",
            "telephone_number": "203-855-7551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SANDRA",
        "middle_name": "PAOLA",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-19",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CT",
            "license": "12560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samartharadhya Iyanalli Srishailaradhya, M.D
• J & L Speech Services Inc
• Beverly P Jackson, Ň.D.
• Dorye Emory Jackson, LCSW
• Natalie Lynn Jackson, LCSW
• Sherin Jacob, RPH
• Chelsea Jacoby
• Hamid A Jafri, MD
• James F Wood DDS PC
• Anna M Jamrozik, MD

• Pediatric Nurse Practitioner in Norwalk, CT
• Providers in Norwalk, CT by specialty
• Pediatric Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.