Sandra Dawn Fomenko, MSN, AGPCNP-BC, CPNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

004756 Issued in CT

Practice address

1952 Whitney Ave Ste 3
Hamden, CT 06517-1209

Phone

(203) 848-1803

NPI assigned

Oct 22, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Master of Science - Nursing

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

{
    "created_epoch": "1319241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648512000000",
    "number": "1437435419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1952 WHITNEY AVE STE 3",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065171209",
            "telephone_number": "203-848-1803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1952 WHITNEY AVE STE 3",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065171209",
            "telephone_number": "203-848-1803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOMENKO",
        "first_name": "SANDRA",
        "middle_name": "DAWN",
        "credential": "MSN, AGPCNP-BC, CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-22",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CT",
            "license": "004756",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CT",
            "license": "004756",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236346",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Health Nurse Practitioner in Hamden, CT
• Providers in Hamden, CT by specialty
• Adult Health Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; 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.