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General NPI Number Information
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NPI Number | 1801615802
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Entity Type | Individual
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Provider Name | SHAY ELIZABETH VENTRESCA ATC, NREMT
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Gender | Female
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 40 DIBIASI DR
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City | NEW LONDON
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State | CT
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Zip | 06320
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Country | US
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Telephone | 860-460-8093
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Fax |
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Provider Business Mailing Address
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Address Line | 36 DAMATO DR
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City | OAKDALE
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State | CT
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Zip | 06370-1694
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Country | US
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Telephone | 860-460-8093
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1929
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License Number State | CT
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