Healthcare Provider Details

I. General information

NPI: 1649978404
Provider Name (Legal Business Name): KRISTIE DELVECCHIO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 02/21/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 STATE HIGHWAY 23
ONEONTA NY
13820-4508
US

IV. Provider business mailing address

2615 STATE ROUTE 10
SUMMIT NY
12175-2504
US

V. Phone/Fax

Practice location:
  • Phone: 607-376-5346
  • Fax:
Mailing address:
  • Phone: 518-221-5003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF351060-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: