Healthcare Provider Details

I. General information

NPI: 1881339695
Provider Name (Legal Business Name): SALLY A. RODEN-TIMKO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 BRIDGE ST UNIT 3
NAUGATUCK CT
06770-9207
US

IV. Provider business mailing address

1290 SILAS DEANE HWY HHC CVO
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 475-285-0634
  • Fax: 475-285-0635
Mailing address:
  • Phone: 860-972-5507
  • Fax: 860-972-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5626
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: