Provider Demographics
NPI:1871689679
Name:SCHJAVLAND, ELENA (APRN)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:SCHJAVLAND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 EAST MAIN ST.
Mailing Address - Street 2:PO BOX 625
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-0625
Mailing Address - Country:US
Mailing Address - Phone:860-908-9799
Mailing Address - Fax:860-245-4145
Practice Address - Street 1:20 BURROWS ST
Practice Address - Street 2:KEYS2MEMORY, LLC
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-2445
Practice Address - Country:US
Practice Address - Phone:860-245-4144
Practice Address - Fax:860-245-4145
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002017363LA2200X, 363LP0808X
CT#002017363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004020178Medicaid
CTP02581Medicare UPIN
CT500000409 (C00814)Medicare PIN