MEDICARE: NICOLE PELUSO IBCLC

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	174N00000X	Lactation Consultant (Non-RN)	11174390	CA
2	174N00000X	Lactation Consultant (Non-RN)	L-24523	CT

General Provider Information

NPI Number	:	1952660946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE PELUSO IBCLC

Provider Business Mailing Address
First Line	:	13 FOX CHASE RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-3005
Country	:	US
Telephone Number	:	203-614-9030
Fax Number	:	310-872-1533

Provider Business Practice Location Address
First Line	:	1 BROAD ST UNIT 16F
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06901-2334
Country	:	US
Telephone Number	:	203-614-9030
Fax Number	:	310-872-1533

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

Provider Enumeration Date	:	05/10/2012
Last Update Date	:	05/04/2026

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Directions to “ NICOLE PELUSO IBCLC” Practice Location

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