Healthcare Provider Details

I. General information

NPI: 1689932956
Provider Name (Legal Business Name): ADRIANA M. VANNUCCI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 STATE ST FL 13
ALBANY NY
12207-2512
US

IV. Provider business mailing address

69 STATE ST FL 13
ALBANY NY
12207-2512
US

V. Phone/Fax

Practice location:
  • Phone: 518-797-4354
  • Fax:
Mailing address:
  • Phone: 203-516-1688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number280243
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: