Provider Demographics
NPI:1871907642
Name:AGRAWAL, SABHYATA
Entity type:Individual
Prefix:
First Name:SABHYATA
Middle Name:
Last Name:AGRAWAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HAVILAND ST UNIT B5
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-3091
Mailing Address - Country:US
Mailing Address - Phone:917-657-2196
Mailing Address - Fax:
Practice Address - Street 1:1 PARK ST # WP-2
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06504-8901
Practice Address - Country:US
Practice Address - Phone:203-785-4081
Practice Address - Fax:737-737-7635
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT643992080S0012X, 2080P0214X
CT63373390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Multi-Specialty
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program