Healthcare Provider Details

I. General information

NPI: 1265173009
Provider Name (Legal Business Name): JOSEPH ELLIS CARAVELLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3170 WEST ST
CANANDAIGUA NY
14424-1712
US

IV. Provider business mailing address

6343 CEDAR CREEK WAY
FARMINGTON NY
14425-9636
US

V. Phone/Fax

Practice location:
  • Phone: 585-396-6990
  • Fax:
Mailing address:
  • Phone: 504-343-2675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number335981
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: