Healthcare Provider Details

I. General information

NPI: 1275044539
Provider Name (Legal Business Name): CHARLOTTE L CUSANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 PRINCE ST STE 207
NEW HAVEN CT
06519-1600
US

IV. Provider business mailing address

15 MIKEYS WAY
NORTH HAVEN CT
06473-3594
US

V. Phone/Fax

Practice location:
  • Phone: 203-787-2264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number7281
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number424
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: