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 1:173 N WAWECUS HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-4062
Mailing Address - Country:US
Mailing Address - Phone:860-480-0135
Mailing Address - Fax:330-493-8677
Practice Address - Street 1:624 W MAIN ST STE 140
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-6043
Practice Address - Country:US
Practice Address - Phone:860-200-8098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2019-08-02
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