Basic Information
Provider Information | |||||||||
NPI: | 1013116730 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SANTHAPPA | ||||||||
FirstName: | SHEILA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1290 SILAS DEANE HIGHWAY | ||||||||
Address2: | HARTFORD HEALTHCARE CVO PROVIDER ENROLLMENT | ||||||||
City: | WETHERSFIELD | ||||||||
State: | CT | ||||||||
PostalCode: | 061094337 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8609729047 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 100 GRAND ST | ||||||||
Address2: |   | ||||||||
City: | NEW BRITAIN | ||||||||
State: | CT | ||||||||
PostalCode: | 060522016 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6082245305 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/12/2007 | ||||||||
LastUpdateDate: | 05/17/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/28/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | MD60342170 | WA | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | ME117068 | FL | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 63748 | CT | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
ID | Type | State | Issuer | Description | 14RC5 | 01 | FL | BCBS | OTHER | 4947399 | 01 | FL | AETNA | OTHER | 009649700 | 05 | FL |   | MEDICAID | 3522839 | 01 | FL | CIGNA | OTHER | P01224659 | 01 | FL | RAILROAD MEDICARE | OTHER |