Healthcare Provider Details

I. General information

NPI: 1982135075
Provider Name (Legal Business Name): CARLEE CARRANZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 IRVING AVE
SYRACUSE NY
13210-1602
US

IV. Provider business mailing address

736 IRVING AVE
SYRACUSE NY
13210-1602
US

V. Phone/Fax

Practice location:
  • Phone: 315-470-7311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number342781-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A16667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: