Provider Demographics
NPI:1619104551
Name:TADDEI, MATTHEW VINCENT (LPN)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:VINCENT
Last Name:TADDEI
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A CO 121 CSH
Mailing Address - Street 2:UNIT 15244 BOX 151
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96205-5244
Mailing Address - Country:US
Mailing Address - Phone:315-737-3209
Mailing Address - Fax:
Practice Address - Street 1:A CO 121 CSH
Practice Address - Street 2:UNIT 15244 BOX 151
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205-5244
Practice Address - Country:US
Practice Address - Phone:315-737-3209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032102286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital