Healthcare Provider Details

I. General information

NPI: 1164338687
Provider Name (Legal Business Name): ANNA DRYGAS MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SHAWS CV
NEW LONDON CT
06320-4956
US

IV. Provider business mailing address

194 BALLAMAHACK RD
WINDHAM CT
06280-1101
US

V. Phone/Fax

Practice location:
  • Phone: 855-444-5664
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number140-5442
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: