Provider Demographics
NPI:1962116863
Name:BANKS, CARA PETRELLA (IBCLC)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:PETRELLA
Last Name:BANKS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 TURNER HILL RD
Mailing Address - Street 2:
Mailing Address - City:AVERILL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12018-4020
Mailing Address - Country:US
Mailing Address - Phone:925-989-9748
Mailing Address - Fax:
Practice Address - Street 1:96 TURNER HILL RD
Practice Address - Street 2:
Practice Address - City:AVERILL PARK
Practice Address - State:NY
Practice Address - Zip Code:12018-4020
Practice Address - Country:US
Practice Address - Phone:925-989-9748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-310439174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN