Provider Demographics
NPI:1780404384
Name:FUSCO, DIONO
Entity type:Individual
Prefix:
First Name:DIONO
Middle Name:
Last Name:FUSCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2890 NW TREVISO CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-6307
Mailing Address - Country:US
Mailing Address - Phone:954-274-0418
Mailing Address - Fax:
Practice Address - Street 1:1165 SW 27TH ST
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2907
Practice Address - Country:US
Practice Address - Phone:772-255-6565
Practice Address - Fax:772-273-2096
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9666497163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse