Provider Demographics
NPI:1477716595
Name:TADDEO, MARYELAINE (RN)
Entity Type:Individual
Prefix:
First Name:MARYELAINE
Middle Name:
Last Name:TADDEO
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 1:16 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-2620
Mailing Address - Country:US
Mailing Address - Phone:508-655-2749
Mailing Address - Fax:
Practice Address - Street 1:16 3RD ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-2620
Practice Address - Country:US
Practice Address - Phone:508-655-2749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA131944163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health