MEDICARE: ZULIAM IVELISEE GONZALEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	008173	CT

General Provider Information

NPI Number	:	1346108198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZULIAM IVELISEE GONZALEZ

Provider Business Mailing Address
First Line	:	245 BENHAM RD APT 13
Second Line	:
City	:	GROTON
State	:	CT
Zip	:	06340-5074
Country	:	US
Telephone Number	:	787-394-5498
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 DROZDYK DR
Second Line	:
City	:	GROTON
State	:	CT
Zip	:	06340-4248
Country	:	US
Telephone Number	:	860-610-0400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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Directions to “ ZULIAM IVELISEE GONZALEZ ” Practice Location

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