Healthcare Provider Details

I. General information

NPI: 1710051909
Provider Name (Legal Business Name): ALBERTO NICANDRO VELASCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CLARA BARTON ST
DANSVILLE NY
14437-9503
US

IV. Provider business mailing address

120 HARDWOOD DR
TAPPAN NY
10983-1100
US

V. Phone/Fax

Practice location:
  • Phone: 585-335-6001
  • Fax:
Mailing address:
  • Phone: 845-274-2516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number166344-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: