Provider Demographics
NPI:1174044523
Name:CUCINELLO, MARY (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CUCINELLO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SPARKILL AVE
Mailing Address - Street 2:
Mailing Address - City:TAPPAN
Mailing Address - State:NY
Mailing Address - Zip Code:10983
Mailing Address - Country:US
Mailing Address - Phone:845-365-6674
Mailing Address - Fax:
Practice Address - Street 1:21 SPARKILL AVE
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983-2208
Practice Address - Country:US
Practice Address - Phone:845-365-6674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY366090-1163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics