Healthcare Provider Details

I. General information

NPI: 1437964350
Provider Name (Legal Business Name): CHARITY GRACE HUNTER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6227 THOMPSON RD
SYRACUSE NY
13206-1405
US

IV. Provider business mailing address

2010 CHARD RD
CAZENOVIA NY
13035-9379
US

V. Phone/Fax

Practice location:
  • Phone: 315-937-2007
  • Fax:
Mailing address:
  • Phone: 315-383-3521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number352050
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: