Healthcare Provider Details

I. General information

NPI: 1316856784
Provider Name (Legal Business Name): TRACI CAPPIELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 GENESEE ST
LOCKPORT NY
14094-4424
US

IV. Provider business mailing address

1317 EDGEWATER DR # 6925
ORLANDO FL
32804-6350
US

V. Phone/Fax

Practice location:
  • Phone: 716-221-0235
  • Fax:
Mailing address:
  • Phone: 631-772-9692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: