Healthcare Provider Details

I. General information

NPI: 1255724746
Provider Name (Legal Business Name): EVELYN FLAHERTY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LOCK ST
NEW HAVEN CT
06511
US

IV. Provider business mailing address

322 EAST MAIN ST SUITE 1B PHYSICIANS ALLIANCE OF CONNECTICUT LLC
BRANFORD CT
06405-3136
US

V. Phone/Fax

Practice location:
  • Phone: 203-432-0076
  • Fax:
Mailing address:
  • Phone: 203-488-7228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number94672
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6073
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: