Individual provider · Type 1 NPI

Tara Broccolo

Specialist · Irondequoit, NY

NPI number 1821495581 Active

Practice location

2111 Hudson Ave
Irondequoit, NY 14617-4346

Call (585) 520-1783 Map

Mailing address

1628 Glendowan Ter
Webster, NY 14580-8571

Specialties and licenses

TaxonomyCodeLicense
Specialist Primary 174400000X649366951 (NY)

Specialist: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

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About NPI 1821495581

Tara Broccolo's National Provider Identifier is 1821495581, issued on Nov 24, 2014. The primary taxonomy on file is Specialist (174400000X), and the practice location is in Irondequoit, NY. The record was last updated on Nov 24, 2014.