Provider Demographics
NPI:1861027716
Name:ZAVAGLIA, SALLY ANN
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:ZAVAGLIA
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 1:122 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-2340
Mailing Address - Country:US
Mailing Address - Phone:860-552-8102
Mailing Address - Fax:
Practice Address - Street 1:122 SHORE RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-2340
Practice Address - Country:US
Practice Address - Phone:860-552-8102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT09130613OE376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide