Provider Demographics
NPI:1619629714
Name:TACCHINO, SHARA
Entity Type:Individual
Prefix:
First Name:SHARA
Middle Name:
Last Name:TACCHINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARA
Other - Middle Name:
Other - Last Name:POLLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:458 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-2149
Mailing Address - Country:US
Mailing Address - Phone:518-483-6566
Mailing Address - Fax:518-481-4213
Practice Address - Street 1:458 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-2149
Practice Address - Country:US
Practice Address - Phone:518-483-6566
Practice Address - Fax:518-481-4213
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21026101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)