Provider Demographics
NPI:1245462589
Name:CAULFIELD, KELSEY EJZAK (PA)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:EJZAK
Last Name:CAULFIELD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:KELSEY
Other - Middle Name:ELIZABETH
Other - Last Name:EJZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3654
Mailing Address - Country:US
Mailing Address - Phone:860-358-4870
Mailing Address - Fax:
Practice Address - Street 1:270 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1836
Practice Address - Country:US
Practice Address - Phone:860-358-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CT2312363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant