Provider Demographics
NPI:1376733006
Name:FUSCO, TAMMY LOUISE (RN)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LOUISE
Last Name:FUSCO
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 1:691 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-1025
Mailing Address - Country:US
Mailing Address - Phone:716-655-6393
Mailing Address - Fax:
Practice Address - Street 1:5240 BROOKHAVEN DR
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1612
Practice Address - Country:US
Practice Address - Phone:716-759-6707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY369-396-1163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02666851Medicaid