Healthcare Provider Details

I. General information

NPI: 1407389240
Provider Name (Legal Business Name): WHITNEY KUKOL MAZZONI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2017
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 E GENESEE ST STE 101
AUBURN NY
13021-4112
US

IV. Provider business mailing address

17 LANSING ST
AUBURN NY
13021-1983
US

V. Phone/Fax

Practice location:
  • Phone: 315-253-5151
  • Fax:
Mailing address:
  • Phone: 315-255-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number320757
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: