Provider Demographics
NPI:1215096359
Name:TADDEO, PATRICIA (PA)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:TADDEO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:MARTIN TADDEO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:367 FULLE DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989
Mailing Address - Country:US
Mailing Address - Phone:845-353-0199
Mailing Address - Fax:
Practice Address - Street 1:107 WEST FOURTH ST
Practice Address - Street 2:MOUNT VERNON NEIGHBORHOOD HEALTH CENTER
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550
Practice Address - Country:US
Practice Address - Phone:914-699-7200
Practice Address - Fax:914-668-0579
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000454363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant