Individual
SANDRA DAWN FOMENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, AGPCNP-BC, CPNP
Contact information
Practice address
1952 WHITNEY AVE STE 3, HAMDEN, CT 06517-1209
(203) 848-1803
Mailing address
1952 WHITNEY AVE STE 3, HAMDEN, CT 06517-1209
(203) 848-1803
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
004756
CT
363LP0200X
Pediatric Nurse Practitioner
004756
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236346
—
CT
Enumeration date
10/22/2011
Last updated
03/29/2022
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