Provider Demographics
NPI:1265678718
Name:ZICCARELLI, MARIA C (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:C
Last Name:ZICCARELLI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 SETON RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2052
Mailing Address - Country:US
Mailing Address - Phone:716-833-6608
Mailing Address - Fax:
Practice Address - Street 1:79 SETON RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2052
Practice Address - Country:US
Practice Address - Phone:716-833-6608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331556-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health