Provider Demographics
NPI:1508092339
Name:COSTA, RACHEL ELIZABETH (BS/MS)
Entity Type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:COSTA
Suffix:
Gender:F
Credentials:BS/MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 ELMCREST DR
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3322
Mailing Address - Country:US
Mailing Address - Phone:845-978-2343
Mailing Address - Fax:845-485-4895
Practice Address - Street 1:16 WEDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1432
Practice Address - Country:US
Practice Address - Phone:845-705-9174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009903172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker