Provider Demographics
NPI:1215007919
Name:DACRUZ, ALLYSON LEIGH (PAC, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:LEIGH
Last Name:DACRUZ
Suffix:
Gender:F
Credentials:PAC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E HILL RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-2116
Mailing Address - Country:US
Mailing Address - Phone:860-461-5753
Mailing Address - Fax:
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1956
Practice Address - Country:US
Practice Address - Phone:860-679-2397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTL-68965174N00000X
CT001802363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No174N00000XOther Service ProvidersLactation Consultant, Non-RN