Provider Demographics
NPI:1710192224
Name:CONNAUGHTON, SALLY A
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:CONNAUGHTON
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 1:3322 COLORADO BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6864
Mailing Address - Country:US
Mailing Address - Phone:940-387-7588
Mailing Address - Fax:940-566-0881
Practice Address - Street 1:3322 COLORADO BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6864
Practice Address - Country:US
Practice Address - Phone:940-387-7588
Practice Address - Fax:940-566-0881
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104146246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist