Healthcare Provider Details

I. General information

NPI: 1982330122
Provider Name (Legal Business Name): CHRISTINA T FAZIO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 05/24/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 INTREPID LN
SYRACUSE NY
13205-2545
US

IV. Provider business mailing address

1001 W FAYETTE ST STE 400
SYRACUSE NY
13204-2866
US

V. Phone/Fax

Practice location:
  • Phone: 315-218-7020
  • Fax: 315-218-7050
Mailing address:
  • Phone: 315-937-3026
  • Fax: 315-937-3126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF348184-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: