Provider Demographics
NPI:1245210798
Name:KASULINOUS, GERALDINE A (APRN, PC, FNP)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:A
Last Name:KASULINOUS
Suffix:
Gender:F
Credentials:APRN, PC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 MILLER ST UNIT 71
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1503
Mailing Address - Country:US
Mailing Address - Phone:413-789-7455
Mailing Address - Fax:413-789-7444
Practice Address - Street 1:308 MILLER ST UNIT 71
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-1503
Practice Address - Country:US
Practice Address - Phone:413-789-7455
Practice Address - Fax:413-789-7444
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA178541364SP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAKANS0663OtherMEDICARE ID-TYPE UNSPECIFIED
MAKANS0663OtherMEDICARE ID-TYPE UNSPECIFIED
MAP76361Medicare UPIN