Healthcare Provider Details

I. General information

NPI: 1801572847
Provider Name (Legal Business Name): NICOLE VACCARO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 BENNETT AVE
YONKERS NY
10701-6309
US

IV. Provider business mailing address

191 BENNETT AVE
YONKERS NY
10701-6309
US

V. Phone/Fax

Practice location:
  • Phone: 914-557-0227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: