Healthcare Provider Details

I. General information

NPI: 1881516722
Provider Name (Legal Business Name): MARIANNA F DUDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CROSSROADS DR
FULTON NY
13069-5009
US

IV. Provider business mailing address

3727 GASKIN RD
BALDWINSVILLE NY
13027-9322
US

V. Phone/Fax

Practice location:
  • Phone: 315-887-1840
  • Fax:
Mailing address:
  • Phone: 315-450-2116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: