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General NPI Number Information
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NPI Number | 1851629448
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Entity Type | Individual
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Provider Name | TISA A AYUSO D.O.
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Gender | Female
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Dates
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Enumeration Date | 11/20/2009
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 8915 W CONNELL AVE
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City | MILWAUKEE
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State | WI
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Zip | 53226-3067
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Country | US
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Telephone | 414-266-2932
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Fax |
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Provider Business Mailing Address
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Address Line | 5 PERRYRIDGE RD
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City | GREENWICH
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State | CT
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Zip | 06830-4697
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Country | US
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Telephone | 203-863-3944
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Fax | 203-863-4690
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 048692
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 73136
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 2706-321
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License Number State | WI
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