Healthcare Provider Details

I. General information

NPI: 1528979481
Provider Name (Legal Business Name): LYNN HUONG LY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 HILLSIDE DR
SOUTH WINDSOR CT
06074-1306
US

IV. Provider business mailing address

178 HILLSIDE DR
SOUTH WINDSOR CT
06074-1306
US

V. Phone/Fax

Practice location:
  • Phone: 413-727-2856
  • Fax:
Mailing address:
  • Phone: 413-727-2856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number91358
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: