Healthcare Provider Details

I. General information

NPI: 1265303622
Provider Name (Legal Business Name): ALEXIA LYNN CAVANAUGH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8749 RIVERSIDE HOUSE PATH
BREWERTON NY
13029-9567
US

IV. Provider business mailing address

8749 RIVERSIDE HOUSE PATH
BREWERTON NY
13029-9567
US

V. Phone/Fax

Practice location:
  • Phone: 315-877-6881
  • Fax:
Mailing address:
  • Phone: 315-877-6881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number356941
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: