Healthcare Provider Details

I. General information

NPI: 1679482665
Provider Name (Legal Business Name): COURTNEY WALDRON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 BRITTONFIELD PKWY
EAST SYRACUSE NY
13057-9226
US

IV. Provider business mailing address

110 AQUA WAY
CENTRAL SQUARE NY
13036-2637
US

V. Phone/Fax

Practice location:
  • Phone: 315-499-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number357482
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: