Healthcare Provider Details

I. General information

NPI: 1366813073
Provider Name (Legal Business Name): NICOLE PAONESSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 RIVER RD STE 203
SCHENECTADY NY
12309-1110
US

IV. Provider business mailing address

711 TROY SCHENECTADY RD STE 203
LATHAM NY
12110-2461
US

V. Phone/Fax

Practice location:
  • Phone: 518-381-9355
  • Fax: 518-381-9216
Mailing address:
  • Phone: 518-783-3110
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF340006
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: