Healthcare Provider Details

I. General information

NPI: 1760003339
Provider Name (Legal Business Name): SARAH IANNACONE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH IRVINE APRN

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 LITTLE MEADOW RD
GUILFORD CT
06437-2025
US

IV. Provider business mailing address

179 LITTLE MEADOW RD
GUILFORD CT
06437-2025
US

V. Phone/Fax

Practice location:
  • Phone: 203-815-7745
  • Fax:
Mailing address:
  • Phone: 203-815-7745
  • Fax: 662-479-4074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9098
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: