National Provider Identifier
Keanu Tyler Vaccaro
Keanu Tyler Vaccaro is listed in the NPPES registry with a primary specialty of Licensed Practical Nurse in Rochester, NY and a listed phone number of (719) 574-9115.
Profile Overview
- NPI
- 1285277319
- Provider Type
- Individual
- Primary Specialty
- Licensed Practical Nurse
- Enumeration Date
- October 22, 2019
- Last Updated
- December 23, 2022
Practice Location
- 40 Midland Ave
- Rochester, NY 14621-4050
Phone: (719) 574-9115
Specialties
- Licensed Practical Nurse (164W00000X)
Full Record
- NPI
- 1285277319
- Entity Type
- Individual
- Last Name
- Vaccaro
- First Name
- Keanu
- Middle Name
- Tyler
- Mailing Street Address
- 40 Midland Ave
- Mailing City
- Rochester
- Mailing State
- NY
- Mailing ZIP Code
- 14621-4050
- Mailing Country
- US
- Practice Street Address
- 40 Midland Ave
- Practice City
- Rochester
- Practice State
- NY
- Practice ZIP Code
- 14621-4050
- Practice Country
- US
- Practice Phone
- (719) 574-9115
- Enumeration Date
- October 22, 2019
- Last Updated
- December 23, 2022
- Sex
- Male
- Sole Proprietor
- No
- Certification Date
- December 23, 2022
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Licensed Practical Nurse (164W00000X)