MEDICARE: MISS ASHLEY NASCIMENTO PA-C

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	363A00000X	Physician Assistant	003621	CT

General Provider Information

NPI Number	:	1396287389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ASHLEY NASCIMENTO PA-C

Provider Business Mailing Address
First Line	:	162 BEARDSLEY ROAD
Second Line	:
City	:	SHELTON
State	:	CT
Zip	:	06484
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 STONY HILL RD
Second Line	:
City	:	BETHEL
State	:	CT
Zip	:	06801-1053
Country	:	US
Telephone Number	:	203-456-8000
Fax Number	:

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

Provider Enumeration Date	:	11/08/2016
Last Update Date	:	05/31/2018

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