Provider Demographics
NPI:1700949773
Name:GORINO, THERESA ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ANN
Last Name:GORINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-2606
Mailing Address - Country:US
Mailing Address - Phone:585-236-9336
Mailing Address - Fax:585-271-7948
Practice Address - Street 1:2316 DELAWARE AVENUE
Practice Address - Street 2:PMB 258
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-2606
Practice Address - Country:US
Practice Address - Phone:585-236-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY453962-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01945720Medicaid