Healthcare Provider Details

I. General information

NPI: 1326446899
Provider Name (Legal Business Name): MEGAN KIM RICCOBONO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 HARRISON ST
SYRACUSE NY
13210-2695
US

IV. Provider business mailing address

600 E GENESEE ST STE 232
SYRACUSE NY
13202-3108
US

V. Phone/Fax

Practice location:
  • Phone: 315-260-4432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number307296
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404075
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: