Provider Demographics
NPI:1245674720
Name:GLENNEY, SANDRA A (DNP)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:A
Last Name:GLENNEY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:520 SAYBROOK RD STE 100B
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4700
Mailing Address - Country:US
Mailing Address - Phone:860-347-8850
Mailing Address - Fax:860-347-6774
Practice Address - Street 1:520 SAYBROOK RD STE 100B
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4700
Practice Address - Country:US
Practice Address - Phone:860-347-8850
Practice Address - Fax:860-347-6774
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT006352363LP2300X, 363L00000X
CT82526163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant