Provider Demographics
NPI:1083505994
Name:VILLAESCUSA, ELASMY C
Entity type:Individual
Prefix:
First Name:ELASMY
Middle Name:C
Last Name:VILLAESCUSA
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 1:22141 SW 103RD AVE
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1137
Mailing Address - Country:US
Mailing Address - Phone:305-801-9279
Mailing Address - Fax:
Practice Address - Street 1:22141 SW 103RD AVE
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1137
Practice Address - Country:US
Practice Address - Phone:305-801-9279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty