Healthcare Provider Details

I. General information

NPI: 1053026773
Provider Name (Legal Business Name): JESSICA VALETUTTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1656 CHAMPLIN AVE
UTICA NY
13502-4830
US

IV. Provider business mailing address

132 ONDERDUNK RD
SHARON SPRINGS NY
13459-3524
US

V. Phone/Fax

Practice location:
  • Phone: 315-624-6000
  • Fax:
Mailing address:
  • Phone: 607-238-6698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number779395-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: