Provider Demographics
NPI:1952640195
Name:DELLAGHELFA, DENNIS (HIS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:DELLAGHELFA
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-4045
Mailing Address - Country:US
Mailing Address - Phone:203-754-1338
Mailing Address - Fax:203-754-1338
Practice Address - Street 1:144 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-4045
Practice Address - Country:US
Practice Address - Phone:203-754-1338
Practice Address - Fax:203-754-1338
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT385237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT385OtherCONNECTICUT DEPARTMENT OF PUBLIC HEALTH HEARING INSTRUMENT SPECIALIST