Healthcare Provider Details

I. General information

NPI: 1811946684
Provider Name (Legal Business Name): JUDITH YUST APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WATERVILLE RD
AVON CT
06001-2097
US

IV. Provider business mailing address

21 WATERVILLE RD
AVON CT
06001-2097
US

V. Phone/Fax

Practice location:
  • Phone: 860-674-2691
  • Fax: 860-677-6443
Mailing address:
  • Phone: 860-674-2691
  • Fax: 860-677-6443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number000266
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number000266
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: