MEDICARE: MARY CUCINELLO REGISTERED NURSE

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	163WP0200X	Pediatric Registered Nurse	366090-1	NY

General Provider Information

NPI Number	:	1174044523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CUCINELLO REGISTERED NURSE

Provider Business Mailing Address
First Line	:	21 SPARKILL AVE
Second Line	:
City	:	TAPPAN
State	:	NY
Zip	:	10983
Country	:	US
Telephone Number	:	845-365-6674
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 SPARKILL AVE
Second Line	:
City	:	TAPPAN
State	:	NY
Zip	:	10983-2208
Country	:	US
Telephone Number	:	845-365-6674
Fax Number	:

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

Provider Enumeration Date	:	07/06/2017
Last Update Date	:	06/21/2026

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