MEDICARE: JESSICA DEORDIO FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	348615	NY

General Provider Information

NPI Number	:	1164180204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA DEORDIO FNP

Provider Business Mailing Address
First Line	:	3330 HOWLETT HILL RD
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13215-9641
Country	:	US
Telephone Number	:	315-430-5198
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 UNION AVE STE 904
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13203-1845
Country	:	US
Telephone Number	:	315-430-5198
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	12/06/2021

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