Provider Demographics
NPI:1942296249
Name:HALLORAN, SALLY (RN)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:HALLORAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 SHERMAN AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5238
Mailing Address - Country:US
Mailing Address - Phone:203-787-0117
Mailing Address - Fax:203-777-3559
Practice Address - Street 1:136 SHERMAN AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5238
Practice Address - Country:US
Practice Address - Phone:203-787-0117
Practice Address - Fax:203-777-3559
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE36348163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse