Provider Demographics
NPI:1528065513
Name:TALLEY, SANDRA LEE (PHD, APRN)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEE
Last Name:TALLEY
Suffix:
Gender:F
Credentials:PHD, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-2205
Mailing Address - Country:US
Mailing Address - Phone:203-387-7541
Mailing Address - Fax:203-737-5710
Practice Address - Street 1:85 WILLOW ST
Practice Address - Street 2:BLDG B
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2668
Practice Address - Country:US
Practice Address - Phone:203-737-5609
Practice Address - Fax:203-737-5710
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002290363LP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult