Healthcare Provider Details

I. General information

NPI: 1437623550
Provider Name (Legal Business Name): AVA MILOM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 FOXON RD
EAST HAVEN CT
06513-2038
US

IV. Provider business mailing address

317 FOXON RD
EAST HAVEN CT
06513-2038
US

V. Phone/Fax

Practice location:
  • Phone: 203-529-3271
  • Fax:
Mailing address:
  • Phone: 203-529-3271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF306843-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number11479
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: