Provider Demographics
NPI:1528439312
Name:ACQUARULO, ARIANA
Entity type:Individual
Prefix:
First Name:ARIANA
Middle Name:
Last Name:ACQUARULO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 OXBOW LN
Mailing Address - Street 2:
Mailing Address - City:NORTHFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06472-1162
Mailing Address - Country:US
Mailing Address - Phone:203-484-9133
Mailing Address - Fax:
Practice Address - Street 1:25 CONSTITUTION BLVD S
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4351
Practice Address - Country:US
Practice Address - Phone:203-871-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003428363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant