Provider Demographics
NPI:1093123200
Name:BRACCO, TRACEY (MS/TSHH, MSED)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:
Last Name:BRACCO
Suffix:
Gender:F
Credentials:MS/TSHH, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SOUND BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11789-1738
Mailing Address - Country:US
Mailing Address - Phone:631-255-2141
Mailing Address - Fax:
Practice Address - Street 1:99 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2821
Practice Address - Country:US
Practice Address - Phone:631-281-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator