Provider Demographics
NPI:1093109423
Name:FUSCHILLO, LYNN KAREN (MSED)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:KAREN
Last Name:FUSCHILLO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SEAFORTH LN
Mailing Address - Street 2:
Mailing Address - City:LLOYD HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11743-9788
Mailing Address - Country:US
Mailing Address - Phone:631-549-9402
Mailing Address - Fax:
Practice Address - Street 1:10 SEAFORTH LN
Practice Address - Street 2:
Practice Address - City:LLOYD HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11743-9788
Practice Address - Country:US
Practice Address - Phone:631-549-9402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2322150174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist