=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447356076
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERYL ANN FUSCO APRN, BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2006
-----------------------------------------------------
Last Update Date | 02/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 OLD NEW MILFORD RD SUITE 2A
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06804-2426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-775-3282
-----------------------------------------------------
Fax | 203-775-3282
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 OLD NEW MILFORD RD SUITE 2A LANDMARK OFFICE BUILDING
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06804-2426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-775-3282
-----------------------------------------------------
Fax | 203-775-3478
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | E38542
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 006329
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------