MEDICARE: SOPHIA NICOLE RACANIELLO 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	363LF0000X	Family Nurse Practitioner	358742	NY
2	163W00000X	Registered Nurse	819440	NY

General Provider Information

NPI Number	:	1134096175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA NICOLE RACANIELLO NP

Provider Business Mailing Address
First Line	:	601 ELMWOOD AVE BOX 278984
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14642-0001
Country	:	US
Telephone Number	:	585-275-2559
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 ELMWOOD AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14642-0001
Country	:	US
Telephone Number	:	585-275-2559
Fax Number	:

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

Provider Enumeration Date	:	10/23/2025
Last Update Date	:	03/03/2026

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