Healthcare Provider Details

I. General information

NPI: 1083033666
Provider Name (Legal Business Name): ASHLEY ANNE BRUNO DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 06/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CAMPBELL AVE
WEST HAVEN CT
06516-2770
US

IV. Provider business mailing address

5900 MURRAY AVE
BETHEL PARK PA
15102-3450
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-5711
  • Fax: 203-937-3845
Mailing address:
  • Phone: 412-722-8716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000960
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: