1336861814 NPI number — AMANDA ALICE CAGGIANO COLES RN

Table of content: AMANDA ALICE CAGGIANO COLES RN (NPI 1336861814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336861814 NPI number — AMANDA ALICE CAGGIANO COLES RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLES
Provider First Name:
AMANDA
Provider Middle Name:
ALICE CAGGIANO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAGGIANO
Provider Other First Name:
AMANDA
Provider Other Middle Name:
ALICE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336861814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 HIGH MEADOW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01062-2625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-590-3801
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
830 SILVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGAWAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01001-2990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-363-1039
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  RN2281792 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0808X , with the licence number: RN2281792 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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