Healthcare Provider Details

I. General information

NPI: 1124591961
Provider Name (Legal Business Name): ERIN CAVALLO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 09/29/2026
Certification Date: 01/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5108 VELASKO RD STE 2000
SYRACUSE NY
13215-1982
US

IV. Provider business mailing address

4971 NORTHFIELD RD
SYRACUSE NY
13215-1249
US

V. Phone/Fax

Practice location:
  • Phone: 315-607-9417
  • Fax: 800-675-9814
Mailing address:
  • Phone: 315-256-7552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403522
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number725928
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: