Elisha Niccole Cusumano, MS, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

264 Hickey Gym
1 Shields Ave
Davis, CA 95616

Phone

(541) 335-9787

NPI assigned

Jan 16, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547596800000",
    "number": "1831663434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3501 37TH ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958173624",
            "telephone_number": "541-335-9787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 HICKEY GYM",
            "address_2": "1 SHIELDS AVE",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "95616",
            "telephone_number": "541-335-9787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSUMANO",
        "first_name": "ELISHA",
        "middle_name": "NICCOLE",
        "credential": "MS, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-16",
        "last_updated": "2019-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Davis, CA
• Providers in Davis, CA by specialty
• Athletic Trainer in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.