Provider Demographics
NPI:1730346081
Name:MOODY, SHEILA (PRESIDENT)
Entity type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:
Last Name:MOODY
Suffix:
Gender:F
Credentials:PRESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 GLEMBY ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-4413
Mailing Address - Country:US
Mailing Address - Phone:203-387-8699
Mailing Address - Fax:203-387-8699
Practice Address - Street 1:47 GLEMBY ST
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-4413
Practice Address - Country:US
Practice Address - Phone:203-387-8699
Practice Address - Fax:203-387-8699
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0923264171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator