Healthcare Provider Details

I. General information

NPI: 1487516332
Provider Name (Legal Business Name): GABRIELLE AUTUMN WOLF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 HILL AND DALE RD
CORTLANDT MANOR NY
10567-6107
US

IV. Provider business mailing address

34 HILL AND DALE RD
CORTLANDT MANOR NY
10567-6107
US

V. Phone/Fax

Practice location:
  • Phone: 347-768-0224
  • Fax:
Mailing address:
  • Phone: 347-768-0224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: