Healthcare Provider Details

I. General information

NPI: 1720068356
Provider Name (Legal Business Name): JUDITH A NELLI NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDY A NELLI NP-C

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 HINSDALE RD
CAMILLUS NY
13031-1648
US

IV. Provider business mailing address

1001 W FAYETTE ST STE 400
SYRACUSE NY
13204-2859
US

V. Phone/Fax

Practice location:
  • Phone: 315-488-0996
  • Fax: 315-488-1955
Mailing address:
  • Phone: 315-472-1488
  • Fax: 315-472-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF330947
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.15207
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: