Healthcare Provider Details

I. General information

NPI: 1871950477
Provider Name (Legal Business Name): SHELLEY VICTORIA HALLIGAN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 WASHINGTON AVE
NORTH HAVEN CT
06473-1149
US

IV. Provider business mailing address

556 WASHINGTON AVE
NORTH HAVEN CT
06473-1149
US

V. Phone/Fax

Practice location:
  • Phone: 203-779-5799
  • Fax: 203-421-6830
Mailing address:
  • Phone: 203-779-5799
  • Fax: 203-421-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number076207
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7829
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: