Healthcare Provider Details

I. General information

NPI: 1114841020
Provider Name (Legal Business Name): EMILY ROSS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ELIZABETH ST
BRANFORD CT
06405-5501
US

IV. Provider business mailing address

4 ELIZABETH ST
BRANFORD CT
06405-5501
US

V. Phone/Fax

Practice location:
  • Phone: 203-687-7332
  • Fax:
Mailing address:
  • Phone: 203-687-7332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN41877
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: