Provider Demographics
NPI:1952815938
Name:PIZZOLO, BREANNA ROSA (MS ED)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:ROSA
Last Name:PIZZOLO
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 OAKDALE ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2608
Mailing Address - Country:US
Mailing Address - Phone:718-702-4326
Mailing Address - Fax:
Practice Address - Street 1:78 OAKDALE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-2608
Practice Address - Country:US
Practice Address - Phone:718-702-4326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program