MEDICARE: CIERA RAE DENOVELLIS FNP-BC

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	352333	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932988243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CIERA RAE DENOVELLIS FNP-BC

Provider Business Mailing Address
First Line	:	6 WELLNESS WAY STE 201
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-2156
Country	:	US
Telephone Number	:	518-782-3700
Fax Number	:	518-782-3799

Provider Business Practice Location Address
First Line	:	6 WELLNESS WAY STE 108
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-2142
Country	:	US
Telephone Number	:	518-370-7937
Fax Number	:	518-377-2983

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

Provider Enumeration Date	:	09/26/2023
Last Update Date	:	05/05/2026

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