MEDICARE: SANDRA GAETANO FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F330584-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	500016106	OTHER	NY	RRMCR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023007010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA GAETANO FNP

Provider Business Mailing Address
First Line	:	4401 MIDDLE SETTLEMENT RD
Second Line	:
City	:	NEW HARTFORD
State	:	NY
Zip	:	13413-5331
Country	:	US
Telephone Number	:	315-738-1835
Fax Number	:	315-797-2419

Provider Business Practice Location Address
First Line	:	4401 MIDDLE SETTLEMENT RD
Second Line	:
City	:	NEW HARTFORD
State	:	NY
Zip	:	13413-5331
Country	:	US
Telephone Number	:	315-738-1835
Fax Number	:	315-797-2419

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	03/15/2013

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