Provider Demographics
NPI:1497357107
Name:PALAZZO, TERESA L (RN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:PALAZZO
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 1:1357 GARDINER DR
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-3728
Mailing Address - Country:US
Mailing Address - Phone:516-429-6450
Mailing Address - Fax:
Practice Address - Street 1:1357 GARDINER DR
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-3728
Practice Address - Country:US
Practice Address - Phone:516-429-6450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY743021163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse