Leah Bueneman, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5639 Issued in CT

Practice address

55 Willow St
Mystic, CT 06355-2636

Phone

(860) 572-6868

NPI assigned

Nov 11, 2019

Last updated

Apr 8, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1573430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649376000000",
    "number": "1841835154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 WINDWARD LN",
            "city": "OLD LYME",
            "state": "CT",
            "postal_code": "063711861",
            "telephone_number": "410-310-3021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 WILLOW ST",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063552636",
            "telephone_number": "860-572-6868"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1300 Hospital Dr Ste 120",
            "address_purpose": "LOCATION",
            "city": "Mount Pleasant",
            "state": "SC",
            "postal_code": "294643204",
            "country_code": "US",
            "telephone_number": "843-849-8418",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUENEMAN",
        "first_name": "LEAH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-11",
        "last_updated": "2022-04-08",
        "certification_date": "2022-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "3372",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "5639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara Jean Bronson, ED.D.
• Daniel Stubbs Brown, LCSW
• Meghan B Brunnock, PA-C
• Linda M Brustolon, LPTA
• Kim Michelle Bucko, OTR
• Danielle Mae Buffington, LCSW
• Stephanie Buske
• Tess Marie Cagenello
• Etny Raul Candelario, MD
• Edmond Francis Cardinal Jr., MSPT

• Physician Assistant in Mystic, CT
• Providers in Mystic, CT by specialty
• Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2022; 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.