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General NPI Number Information
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NPI Number | 1881339695
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Entity Type | Individual
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Provider Name | SALLY A. RODEN-TIMKO PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/05/2022
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 112 BRIDGE ST UNIT 3
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City | NAUGATUCK
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State | CT
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Zip | 06770-9207
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Country | US
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Telephone | 475-285-0634
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Fax | 475-285-0635
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Provider Business Mailing Address
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Address Line | 1290 SILAS DEANE HWY HHC CVO
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City | WETHERSFIELD
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State | CT
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Zip | 06109-4337
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Country | US
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Telephone | 860-972-5507
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Fax | 860-972-7040
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5626
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License Number State | CT
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