Healthcare Provider Details

I. General information

NPI: 1902444045
Provider Name (Legal Business Name): ANNA HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 OSBORNE ST FL 2
DANBURY CT
06810-6000
US

IV. Provider business mailing address

90 GALLOWS HILL RD
REDDING CT
06896-1409
US

V. Phone/Fax

Practice location:
  • Phone: 203-739-7038
  • Fax:
Mailing address:
  • Phone: 917-744-2363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: