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NPI Code Detail

MEDICARE: GABRIELLE AUTUMN WOLF

MEDICARE: GABRIELLE AUTUMN WOLF
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1487516332
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIELLE AUTUMN WOLF
Provider Business Mailing Address
First Line : 34 HILL AND DALE RD
Second Line :
City : CORTLANDT MANOR
State : NY
Zip : 10567-6107
Country : US
Telephone Number : 347-768-0224
Fax Number :
Provider Business Practice Location Address
First Line : 34 HILL AND DALE RD
Second Line :
City : CORTLANDT MANOR
State : NY
Zip : 10567-6107
Country : US
Telephone Number : 347-768-0224
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2025
Last Update Date : 12/01/2025

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Directions to “ GABRIELLE AUTUMN WOLF ” Practice Location

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