MEDICARE: MS. XYDITA C VLAZZIO LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	326550	NY

General Provider Information

NPI Number	:	1811214620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. XYDITA C VLAZZIO LPN

Provider Business Mailing Address
First Line	:	2425 NOSTRAND AVE APT 311
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4019
Country	:	US
Telephone Number	:	646-671-0819
Fax Number	:

Provider Business Practice Location Address
First Line	:	1407 N MARTIN LUTHER KING DR
Second Line	:	108
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-3976
Country	:	US
Telephone Number	:	414-943-0248
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2010
Last Update Date	:	03/21/2023

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