Provider Demographics
NPI:1710344171
Name:STUCCIO, NINA
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:
Last Name:STUCCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S FRONT ST UNIT 215
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1708
Mailing Address - Country:US
Mailing Address - Phone:805-509-9265
Mailing Address - Fax:
Practice Address - Street 1:410 S FRONT ST UNIT 215
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1708
Practice Address - Country:US
Practice Address - Phone:805-509-9265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005442L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology