Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tara Broccolo

Individual provider Specialist · NPI 1821495581

Tara Broccolo is a Specialist in Irondequoit, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2014
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Practice location Address checks out

2111 Hudson Ave
Irondequoit, NY 14617-4346
Phone: (585) 520-1783
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence 649366951 (NY)

Record details

NPI number1821495581
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedNovember 24, 2014
Last updated in NPPESNovember 24, 2014

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