Provider Demographics
NPI:1649971698
Name:PROTO, ELIZABETH MARIA (AUD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MARIA
Last Name:PROTO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MARIA
Other - Last Name:SHIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:868 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2059
Mailing Address - Country:US
Mailing Address - Phone:631-807-6495
Mailing Address - Fax:
Practice Address - Street 1:868 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2059
Practice Address - Country:US
Practice Address - Phone:631-807-6495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002946-01231H00000X
TX81296231H00000X
CT000723231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist