MEDICARE: NICHOLAS DESTEFANO CRNA

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	367500000X	Certified Registered Nurse Anesthetist	524397	NY
2	367500000X	Certified Registered Nurse Anesthetist	300626	AZ

General Provider Information

NPI Number	:	1417031253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS DESTEFANO CRNA

Provider Business Mailing Address
First Line	:	1450 WESTERN AVE STE 102
Second Line	:	ANESTHESIA GROUP OF ALBANY, PC
City	:	ALBANY
State	:	NY
Zip	:	12203-3539
Country	:	US
Telephone Number	:	518-463-0050
Fax Number	:	518-207-2973

Provider Business Practice Location Address
First Line	:	8500 N ORACLE RD STE 150
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-6511
Country	:	US
Telephone Number	:	520-462-0220
Fax Number	:

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	06/05/2025

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Directions to “ NICHOLAS DESTEFANO CRNA” Practice Location

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