Most Relevant Information
Provider Data
| NPI Number: | 1003182312 |
| Provider Name: | SALLY WALLACE LYNCH MS, CD-N |
| Entity Type: | Individual |
| Taxonomy Code: | 133N00000X |
| Specialty: | Nutritionist |
| License Number: | 000736 |
Most Important Dates
| Enumeration Date: | 03/30/2012 |
| Last Updated: | 03/30/2012 |
Provider Practice Location
11 CRAIGMOOR RD
WEST HARTFORD
CT
061071210
Practice Location Phone/Fax
| Phone: | 8604903920 |
| Fax: |
Provider Mailing Location
11 CRAIGMOOR RD
WEST HARTFORD
CT
061071210
Provider Mailing Phone/Fax
| Phone: | 8604903920 |
| Fax: |