Healthcare Provider Details

I. General information

NPI: 1750992624
Provider Name (Legal Business Name): GIULIANA ROSE CUCCINIELLO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 SHORECREST DR
EAST FALMOUTH MA
02536-5930
US

IV. Provider business mailing address

18 SHORECREST DR
EAST FALMOUTH MA
02536-5930
US

V. Phone/Fax

Practice location:
  • Phone: 908-967-1104
  • Fax:
Mailing address:
  • Phone: 908-967-1104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: