Healthcare Provider Details

I. General information

NPI: 1639085038
Provider Name (Legal Business Name): MRS. TARA LYNN CARUSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 BRIGHTON HENRIETTA TOWN LINE RD
ROCHESTER NY
14623-2532
US

IV. Provider business mailing address

1850 BRIGHTON HENRIETTA TOWN LINE RD
ROCHESTER NY
14623-2532
US

V. Phone/Fax

Practice location:
  • Phone: 585-287-5622
  • Fax:
Mailing address:
  • Phone: 585-287-5622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number924012
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: