MEDICARE: ERIN CAVALLO NP

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	725928	NY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	403522	NY

General Provider Information

NPI Number	:	1124591961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN CAVALLO NP

Provider Business Mailing Address
First Line	:	4971 NORTHFIELD RD
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13215-1249
Country	:	US
Telephone Number	:	315-256-7552
Fax Number	:

Provider Business Practice Location Address
First Line	:	5108 VELASKO RD STE 2000
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13215-1982
Country	:	US
Telephone Number	:	315-607-9417
Fax Number	:	800-675-9814

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

Provider Enumeration Date	:	01/04/2019
Last Update Date	:	01/17/2026

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