Provider Demographics
NPI:1801173877
Name:CARACCIOLO, TERRI LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:LYNN
Last Name:CARACCIOLO
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 1:880 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-1236
Mailing Address - Country:US
Mailing Address - Phone:518-881-2030
Mailing Address - Fax:518-881-3603
Practice Address - Street 1:880 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-1236
Practice Address - Country:US
Practice Address - Phone:518-881-2030
Practice Address - Fax:518-881-3603
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01406986Medicaid