Provider Demographics
NPI:1366084345
Name:CHHEAN, PICHTIDA SARAH
Entity type:Individual
Prefix:
First Name:PICHTIDA
Middle Name:SARAH
Last Name:CHHEAN
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 1:55 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR LOCKS
Mailing Address - State:CT
Mailing Address - Zip Code:06096-2456
Mailing Address - Country:US
Mailing Address - Phone:860-967-6585
Mailing Address - Fax:
Practice Address - Street 1:55 S CENTER ST
Practice Address - Street 2:
Practice Address - City:WINDSOR LOCKS
Practice Address - State:CT
Practice Address - Zip Code:06096-2456
Practice Address - Country:US
Practice Address - Phone:860-967-6585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program