Basic Information
| Provider Information | |||||||||
| NPI: | 1932213584 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELLINGER | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2139 SILAS DEANE HWY | ||||||||
| Address2: | |||||||||
| City: | ROCKY HILL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060672336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602574131 | ||||||||
| FaxNumber: | 8602574519 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 LIBERTY SQ | ||||||||
| Address2: | |||||||||
| City: | NEW BRITAIN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060512636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602299688 | ||||||||
| FaxNumber: | 8602295498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 12/10/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 001824 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LF0000X | 001824 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | D40071170 | 01 | CT | MEDICARE ID | OTHER | 001824 | 01 | CT | CONNECTICARE | OTHER | 004193629 | 05 | CT | MEDICAID | 400001824CT05 | 01 | CT | ANTHEM BC-NEW BRITAIN OFFICE | OTHER |