Healthcare Provider Details

I. General information

NPI: 1306488762
Provider Name (Legal Business Name): SYNERGY ADVANCED HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 BIRD ST STE 4
TORRINGTON CT
06790-3838
US

IV. Provider business mailing address

16 BIRD ST STE 4
TORRINGTON CT
06790-3838
US

V. Phone/Fax

Practice location:
  • Phone: 860-618-7575
  • Fax: 860-618-7576
Mailing address:
  • Phone: 860-618-7575
  • Fax: 860-618-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ALLEN
Title or Position: PARTNER
Credential:
Phone: 203-870-1796