Provider Demographics
NPI:1487851564
Name:KASOV, CAROLYN M (NP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:KASOV
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:M
Other - Last Name:DEMILIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:32 STRAWBERRY HILL CT
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2594
Mailing Address - Country:US
Mailing Address - Phone:203-276-8258
Mailing Address - Fax:203-276-8441
Practice Address - Street 1:32 STRAWBERRY HILL CT
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2594
Practice Address - Country:US
Practice Address - Phone:203-276-8258
Practice Address - Fax:203-276-8441
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY569143163W00000X
NY335223363LF0000X
CT003994363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse