Healthcare Provider Details

I. General information

NPI: 1366407140
Provider Name (Legal Business Name): ALLERGY ASTHMA RHEUMATOLOGY ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5793 WIDEWATERS PKWY STE 250
SYRACUSE NY
13214-1887
US

IV. Provider business mailing address

5793 WIDEWATERS PKWY STE 250
SYRACUSE NY
13214-1887
US

V. Phone/Fax

Practice location:
  • Phone: 315-478-2339
  • Fax: 315-478-0439
Mailing address:
  • Phone: 315-478-2339
  • Fax: 315-478-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SHEEHAN
Title or Position: PARTNER
Credential:
Phone: 315-478-2339