| Doctor Name: | MS. MARYELLEN CUCUZZO |
| NPI Number: | 1003257320 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NURSE PRACTITIONER |
| License Number: | F421100-1 |
| Business Practice Address: | 600 Suffolk Ave Ste C Brentwood, NY - 117174311 |
| Business Phone Number: | 6312733712 |
| Business Fax Number: | 6312733745 |
| Mailing Address: | 123 Singingwood Dr, HOLBROOK |
| State: | NY |
| Postal Code: | 117413024 |
| Phone Number: | 6314724435 |
| Fax Number: | 6314724435 |
| NPI Enumeration Date: | 07/15/2013 |
| NPI Last Update Date: | 07/15/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LW0102X |
| License Number: | F421100-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Women's Health |
| Taxonomy Definition: | |