Provider Demographics
NPI:1689314924
Name:PICCILLO, ELLEN MARY (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARY
Last Name:PICCILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1435
Mailing Address - Country:US
Mailing Address - Phone:716-362-9585
Mailing Address - Fax:
Practice Address - Street 1:1237 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1435
Practice Address - Country:US
Practice Address - Phone:716-362-9585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program