Healthcare Provider Details

I. General information

NPI: 1437047602
Provider Name (Legal Business Name): KARA DESIDERIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CAMPUS RD
ANNANDALE ON HUDSON NY
12504-9800
US

IV. Provider business mailing address

1542 ROUTE 27
CRARYVILLE NY
12521-5411
US

V. Phone/Fax

Practice location:
  • Phone: 845-758-6822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF357033-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: