| Doctor Name: | SANAM MAHMOUD ZADEH POURNAKI |
| NPI Number: | 1447607551 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 555 Willard Ave Newington Vamc, Firm Chief Firm 2 Vact Pri Newington, CT - 061112631 |
| Business Phone Number: | 8668087921 |
| Business Fax Number: | 8606676875 |
| Mailing Address: | 555 Willard Ave, Newington Vamc, Firm Chief Firm 2 Vact Pri NEWINGTON |
| State: | CT |
| Postal Code: | 061112631 |
| Phone Number: | 8668087921 |
| Fax Number: | 8606676875 |
| NPI Enumeration Date: | 05/18/2016 |
| NPI Last Update Date: | 05/18/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |