Healthcare Provider Details

I. General information

NPI: 1477489102
Provider Name (Legal Business Name): CAITLIN NEWBY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 HARRISON ST
SYRACUSE NY
13210-2695
US

IV. Provider business mailing address

719 HARRISON ST
SYRACUSE NY
13210-2695
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-9161
  • Fax: 315-464-3282
Mailing address:
  • Phone: 315-464-3265
  • Fax: 315-464-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408720
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: