Healthcare Provider Details

I. General information

NPI: 1881010577
Provider Name (Legal Business Name): JARED STUTTLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2014
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WEST AVE
SARATOGA SPRINGS NY
12866-6045
US

IV. Provider business mailing address

1 WEST AVE
SARATOGA SPRINGS NY
12866-6045
US

V. Phone/Fax

Practice location:
  • Phone: 518-583-5300
  • Fax:
Mailing address:
  • Phone: 518-583-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: