Healthcare Provider Details

I. General information

NPI: 1326079195
Provider Name (Legal Business Name): DEBRA ANN TASHLEIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 BRADLEY RD UNIT 4
MADISON CT
06443-2662
US

IV. Provider business mailing address

465 GOLF RD
ORANGE CT
06477-2115
US

V. Phone/Fax

Practice location:
  • Phone: 203-545-4416
  • Fax:
Mailing address:
  • Phone: 203-545-4416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number003158
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: