Healthcare Provider Details

I. General information

NPI: 1588489496
Provider Name (Legal Business Name): RICCIO-CAMARDELLO NP IN PSYCHIATRY AND NP IN FAMILY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MAXWELL DR
CLIFTON PARK NY
12065-2926
US

IV. Provider business mailing address

22 ELIZABETH LN
SARATOGA SPRINGS NY
12866-2804
US

V. Phone/Fax

Practice location:
  • Phone: 917-526-1580
  • Fax:
Mailing address:
  • Phone: 917-526-1580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. ALEXANDRA RICCIO
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP-C
Phone: 917-526-1580