Healthcare Provider Details

I. General information

NPI: 1518870021
Provider Name (Legal Business Name): ASHLEY MARIE POTELUNAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 N MAIN STREET EXT STE 101A
WALLINGFORD CT
06492-2449
US

IV. Provider business mailing address

273 MONTICELLO DR
BRANFORD CT
06405-4178
US

V. Phone/Fax

Practice location:
  • Phone: 888-754-0398
  • Fax:
Mailing address:
  • Phone: 475-358-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: