Healthcare Provider Details

I. General information

NPI: 1497416184
Provider Name (Legal Business Name): SURANY ALLISON THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 MIGEON AVE
TORRINGTON CT
06790-4643
US

IV. Provider business mailing address

469 MIGEON AVE
TORRINGTON CT
06790-4643
US

V. Phone/Fax

Practice location:
  • Phone: 860-489-0931
  • Fax:
Mailing address:
  • Phone: 860-489-0931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12.016769
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: