Healthcare Provider Details

I. General information

NPI: 1346214657
Provider Name (Legal Business Name): JOHN A STELLATO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WESTAGE BUS CTR DR STE 202
FISHKILL NY
12524-2266
US

IV. Provider business mailing address

111 CLOCK TOWER CMNS
BREWSTER NY
10509-4055
US

V. Phone/Fax

Practice location:
  • Phone: 845-896-0736
  • Fax: 845-896-4850
Mailing address:
  • Phone: 845-592-4915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number002974
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: