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General NPI Number Information
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NPI Number | 1962829291
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Entity Type | Individual
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Provider Name | VICKI SERVELLO SPECIAL EDUCATION
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Gender | Female
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 171 INTREPID LN
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City | SYRACUSE
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State | NY
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Zip | 13205-2548
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Country | US
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Telephone | 315-437-4689
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Fax | 315-437-4690
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Provider Business Mailing Address
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Address Line | 2472 CANDLEWICK LN
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City | MARCELLUS
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State | NY
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Zip | 13108-1044
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Country | US
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Telephone | 315-673-9037
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 534966941
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License Number State | NY
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