MEDICARE: MS. CAROLYN REPUCCI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	781168-01	NY

General Provider Information

NPI Number	:	1083562615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLYN REPUCCI

Provider Business Mailing Address
First Line	:	11 SIENNA CT
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-6172
Country	:	US
Telephone Number	:	978-502-3248
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 SIENNA CT
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-6172
Country	:	US
Telephone Number	:	978-502-3248
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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