Healthcare Provider Details

I. General information

NPI: 1538094412
Provider Name (Legal Business Name): VICTORIA GRACE BARANEK FNP, RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6846 BUCKLEY RD
NORTH SYRACUSE NY
13212-4275
US

IV. Provider business mailing address

12 RIVERBOAT LN
WATERFORD NY
12188-4004
US

V. Phone/Fax

Practice location:
  • Phone: 315-410-6400
  • Fax:
Mailing address:
  • Phone: 518-817-3566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number359870
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: