Healthcare Provider Details

I. General information

NPI: 1003073115
Provider Name (Legal Business Name): BETH LYN VACCARELLI ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2008
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SENECA ST STE 646C
BUFFALO NY
14210-1351
US

IV. Provider business mailing address

300 MERIDIAN CENTRE BLVD SUITE 320
ROCHESTER NY
14618-3981
US

V. Phone/Fax

Practice location:
  • Phone: 716-995-4450
  • Fax:
Mailing address:
  • Phone: 585-463-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number304626
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: