Healthcare Provider Details

I. General information

NPI: 1366379042
Provider Name (Legal Business Name): COMPASSIONATE PAIN CARE & WELLNESS CENTER OF CONNECTICUT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TRAP FALLS RD STE 510
SHELTON CT
06484-7622
US

IV. Provider business mailing address

72 COTTAGE ST
MONROE CT
06468-2917
US

V. Phone/Fax

Practice location:
  • Phone: 203-610-0372
  • Fax: 800-994-9501
Mailing address:
  • Phone: 203-610-0372
  • Fax: 800-994-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: JODY KUSHEBA
Title or Position: OWNER/PROVIDER
Credential: FNP
Phone: 203-610-0372