Healthcare Provider Details

I. General information

NPI: 1255235594
Provider Name (Legal Business Name): ERIN CAVALLO NURSE PRACTITIONER IN PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5108 VELASKO RD STE 2000
SYRACUSE NY
13215-1982
US

IV. Provider business mailing address

5108 VELASKO RD STE 2000
SYRACUSE NY
13215-1982
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERIN CAVALLO
Title or Position: SOLE MEMBER / OWNER
Credential: PMHNP
Phone: 315-607-9417