Doctor Name: | SANDRA BYRNES |
NPI Number: | 1346621612 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 12.006131 |
Business Practice Address: | 175 West Rd Ellington, CT - 060293730 |
Business Phone Number: | 8603759122 |
Business Fax Number: | 8603759133 |
Mailing Address: | 175 West Rd, ELLINGTON |
State: | CT |
Postal Code: | 060293730 |
Phone Number: | 8603759122 |
Fax Number: | 8603759133 |
NPI Enumeration Date: | 06/12/2015 |
NPI Last Update Date: | 06/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 12.006131 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |