MEDICARE: MS. LAURA J CAPUANO

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F404428-01	NY

General Provider Information

NPI Number	:	1083393391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA J CAPUANO

Provider Business Mailing Address
First Line	:	10 E MAIN ST STE 302
Second Line	:
City	:	VICTOR
State	:	NY
Zip	:	14564-1334
Country	:	US
Telephone Number	:
Fax Number	:	585-308-0051

Provider Business Practice Location Address
First Line	:	10 E MAIN ST STE 302
Second Line	:
City	:	VICTOR
State	:	NY
Zip	:	14564-1334
Country	:	US
Telephone Number	:	585-270-0990
Fax Number	:

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

Provider Enumeration Date	:	07/13/2023
Last Update Date	:	03/17/2026

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