Healthcare Provider Details

I. General information

NPI: 1053819292
Provider Name (Legal Business Name): STEPHANIE SLOAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 NORWICK NEW LONDON TURNPIKE
UNCASVILLE CT
06382-2122
US

IV. Provider business mailing address

12 MAPLE RD
QUAKER HILL CT
06375-1117
US

V. Phone/Fax

Practice location:
  • Phone: 267-664-8281
  • Fax: 207-637-1072
Mailing address:
  • Phone: 267-664-8281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number005618
License Number StateCT

VIII. Authorized Official

Name: STEPHANIE JUNE SLOAN
Title or Position: OWNER
Credential: APRN
Phone: 267-664-8281