MEDICARE: ASHLEY ELUSMA

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	363LP0200X	Pediatric Nurse Practitioner	202017582	CT

General Provider Information

NPI Number	:	1447878855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY ELUSMA

Provider Business Mailing Address
First Line	:	360 MEADOWBROOK CT
Second Line	:
City	:	WEST HAVEN
State	:	CT
Zip	:	06516-7857
Country	:	US
Telephone Number	:	203-479-2112
Fax Number	:

Provider Business Practice Location Address
First Line	:	92 NEW LONDON TPKE # 1
Second Line	:
City	:	NORWICH
State	:	CT
Zip	:	06360-2616
Country	:	US
Telephone Number	:	860-889-3835
Fax Number	:

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

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	07/13/2020

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Directions to “ ASHLEY ELUSMA ” Practice Location

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