Healthcare Provider Details

I. General information

NPI: 1720999386
Provider Name (Legal Business Name): MICHAELA MASELLI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 BELLEVUE AVE STE 5
SYRACUSE NY
13219-3233
US

IV. Provider business mailing address

7573 GREENBOUGH CIR
BALDWINSVILLE NY
13027-8438
US

V. Phone/Fax

Practice location:
  • Phone: 315-671-8796
  • Fax: 315-637-3694
Mailing address:
  • Phone: 315-380-6339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF360051-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: