Individual
ELIZABETH FUCCILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
789 PINE ST, BURLINGTON, VT 05401-4924
(802) 864-0693
(802) 860-4324
Mailing address
656 KENT AVE, TEANECK, NJ 07666-1607
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
055.0031603
VT
Other
Enumeration date
06/03/2017
Last updated
11/04/2022
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