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General NPI Number Information
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NPI Number | 1891879730
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Entity Type | Individual
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Provider Name | WENDY D'AVELLA
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 24 S PARK ST ATTN: WENDY D'AVELLA
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City | CAMBRIDGE
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State | NY
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Zip | 12816-1223
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Country | US
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Telephone | 518-677-2653
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Fax | 518-677-2837
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Provider Business Mailing Address
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Address Line | 24 S PARK ST ATTN: WENDY D'AVELLA
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City | CAMBRIDGE
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State | NY
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Zip | 12816-1223
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Country | US
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Telephone | 518-677-2653
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Fax | 518-677-2837
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 413556
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F331372
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License Number State | NY
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