Healthcare Provider Details

I. General information

NPI: 1164267183
Provider Name (Legal Business Name): KATELYN N BURGO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 UNION CENTER HWY STE 205
ENDICOTT NY
13760-1340
US

IV. Provider business mailing address

1635 UNION CENTER HWY STE 205
ENDICOTT NY
13760-1340
US

V. Phone/Fax

Practice location:
  • Phone: 607-357-8668
  • Fax: 607-208-7593
Mailing address:
  • Phone: 607-271-2050
  • Fax: 607-271-2071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406022
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: