Provider Demographics
NPI:1447356076
Name:FUSCO, CHERYL ANN (APRN, BC)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:FUSCO
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Gender:
Credentials:APRN, BC
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Mailing Address - Street 1:2 OLD NEW MILFORD RD
Mailing Address - Street 2:SUITE 2A LANDMARK OFFICE BUILDING
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2426
Mailing Address - Country:US
Mailing Address - Phone:203-775-3282
Mailing Address - Fax:203-775-3478
Practice Address - Street 1:2 OLD NEW MILFORD RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2426
Practice Address - Country:US
Practice Address - Phone:203-775-3282
Practice Address - Fax:203-775-3282
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CTE38542101Y00000X
CT006329363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008062761Medicaid
P3535391OtherOXFORD
194751OtherMHN
890000029Medicare ID - Type Unspecified