Healthcare Provider Details

I. General information

NPI: 1497529242
Provider Name (Legal Business Name): ASHLEY MARIE VACCARO I B.S, M.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 W 1ST ST
OSWEGO NY
13126-2045
US

IV. Provider business mailing address

7941 JOSS FARM WAY
CICERO NY
13039-7007
US

V. Phone/Fax

Practice location:
  • Phone: 315-342-9575
  • Fax:
Mailing address:
  • Phone: 607-237-3836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: