Saybrook Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

SAYBROOK DERMATOLOGY LLC

Practice address

455 Boston Post Rd Ste 10
Old Saybrook, CT 06475-1554

Phone

(860) 388-9799

Fax

(860) 388-6646

NPI assigned

Sep 7, 2006

Last updated

May 25, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Heather Larson

Title

Office Manager

Phone

(860) 388-9799

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Interoperability endpoints

• Direct secure messaging: heather@saybrookdermatology.emadirect.md

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer P Gray, MD

  • Dermatology Physician
  • Old Saybrook, CT
  • NPI 1285644039
  Medicare reassignment Care Compare group NPD
• Michelle Higginson, MD

  • Specialist
  • Old Saybrook, CT
  • NPI 1508969387
  Medicare reassignment Care Compare group NPD
• Alicia D Beck, PA

  • Medical Physician Assistant
  • Old Saybrook, CT
  • NPI 1477838324
  Medicare reassignment Care Compare group
• Leigh Brewster Charron, P.A.-C.

  • Physician Assistant
  • Old Saybrook, CT
  • NPI 1316295504
  Medicare reassignment Care Compare group
• Brittany Giammalvo, RPA-C

  • Physician Assistant
  • Old Saybrook, CT
  • NPI 1033426200
  Medicare reassignment Care Compare group
• Sarah Es Overmoyer, PAC

  • Physician Assistant
  • Old Saybrook, CT
  • NPI 1205807997
  Medicare reassignment
• Siobhan Collins, MD

  • MOHS-Micrographic Surgery Physician
  • Farmington, CT
  • NPI 1790888584

  Dermatology

  NPD (past)
• Diane Guardiani, PMHNP (APRN)

  • Psychiatric/Mental Health Nurse Practitioner
  • Niantic, CT
  • NPI 1316957285
  NPD (past)

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590364800000",
    "number": "1902909708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 BOSTON POST RD STE 10",
            "city": "OLD SAYBROOK",
            "state": "CT",
            "postal_code": "064751554",
            "telephone_number": "860-388-9799",
            "fax_number": "860-388-6646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 BOSTON POST RD STE 10",
            "city": "OLD SAYBROOK",
            "state": "CT",
            "postal_code": "064751554",
            "telephone_number": "860-388-9799",
            "fax_number": "860-388-6646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAYBROOK DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2020-05-25",
        "certification_date": "2020-05-25",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "860-388-9799"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "heather@saybrookdermatology.emadirect.md",
            "affiliation": "N",
            "endpointDescription": "office direct mail address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "455 Boston Post Rd Ste 10",
            "city": "Old Saybrook",
            "state": "CT",
            "country_code": "US",
            "postal_code": "064751554",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brittany Sanchez, LPC
• Nancy Lynn Sandner, RPT
• Emily-Rose Santamaria, LCSW
• Walter Mauricio Saquipulla
• Saybrook Center LLC (Saybrook Counseling Center)
• Saybrook Health Care Center, Inc.
• Saybrook Healthcare Center, Inx (Apple Rehab Saybrook)
• Saybrook Podiatry Associates, PC
• Saybrook Remedy, LLC (Saybrook Remedy)
• Karl Scheibe, PH.D.

• Dermatology Physician in Old Saybrook, CT
• Providers in Old Saybrook, CT by specialty
• Dermatology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.