Saundra Lyn Jezowski

Primary specialty

Other Specialist/TechnologistTaxonomy code 246Z00000X

Practice address

39 New London Tpke Ste 218
Glastonbury, CT 06033-4208

Phone

(407) 982-4876

Fax

(407) 650-2754

NPI assigned

Mar 11, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Dermasology

  • Other Specialist/Technologist
  • Glastonbury, CT
  • NPI 1578362380

  Specialist/Technologist, Other

  NPD

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

{
    "created_epoch": "1710115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755734400000",
    "number": "1306604798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 NEW LONDON TPKE STE 218",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332061",
            "telephone_number": "860-716-4199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 NEW LONDON TPKE STE 218",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060334208",
            "telephone_number": "407-982-4876",
            "fax_number": "407-650-2754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEZOWSKI",
        "first_name": "SAUNDRA",
        "middle_name": "LYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-11",
        "last_updated": "2025-08-21",
        "certification_date": "2025-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CT",
            "license": "654",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jill Soucy, LLC
• Joanne Hutt, PH.D., LLC
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• Ericka Sue Johnson, A.T.,C.
• Shaunte Nicole Johnson, MS

• Other Specialist/Technologist in Glastonbury, CT
• Providers in Glastonbury, CT by specialty
• Other Specialist/Technologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2025; 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.