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General NPI Number Information
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NPI Number | 1790543718
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Entity Type | Individual
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Provider Name | GIANNA VACCA
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Gender | Female
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Dates
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Enumeration Date | 03/13/2024
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 360 WASHINGTON AVE
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City | KINGSTON
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State | NY
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Zip | 12401-3702
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Country | US
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Telephone | 845-338-7410
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Fax |
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Provider Business Mailing Address
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Address Line | 80 GRANDEVILLE CT APT 1232
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City | WAKEFIELD
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State | RI
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Zip | 02879-8215
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Country | US
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Telephone | 401-680-2043
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 034809
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License Number State | NY
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