MEDICARE: CANDICE IBARRA DO

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	207L00000X	Anesthesiology Physician	OS23138	FL
2	207L00000X	Anesthesiology Physician	332053	NY

General Provider Information

NPI Number	:	1275155392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE IBARRA DO

Provider Business Mailing Address
First Line	:	1451 LITTLE WHALENECK RD
Second Line	:
City	:	MERRICK
State	:	NY
Zip	:	11566-1637
Country	:	US
Telephone Number	:	516-502-5853
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 E ADAMS ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13210-1834
Country	:	US
Telephone Number	:	315-464-5540
Fax Number	:

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

Provider Enumeration Date	:	05/12/2020
Last Update Date	:	12/16/2025

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