Provider Demographics
NPI:1962864512
Name:FUSCO, SALLY WARD (RN)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:WARD
Last Name:FUSCO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:SALLY
Other - Middle Name:MAE
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1255 CALDWELL RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3220
Mailing Address - Country:US
Mailing Address - Phone:856-348-1209
Mailing Address - Fax:856-375-8358
Practice Address - Street 1:1255 CALDWELL RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3220
Practice Address - Country:US
Practice Address - Phone:856-348-1209
Practice Address - Fax:856-375-8358
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR08502300163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent