Basic Information
| Provider Information | |||||||||
| NPI: | 1164914586 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUSZA | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | K | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 PEASE FARM RD | ||||||||
| Address2: | |||||||||
| City: | ELLINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060293444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606704384 | ||||||||
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| Practice Location | |||||||||
| Address1: | 271 CAREW ST | ||||||||
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| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011042377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607146654 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2018 | ||||||||
| LastUpdateDate: | 09/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 133977 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.