Provider Demographics
NPI:1487802328
Name:CALTABIANO, CATHLEEN ANNE (PNP)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:ANNE
Last Name:CALTABIANO
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:ANNE
Other - Last Name:DESIMONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:124 PAUL AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-3217
Mailing Address - Country:US
Mailing Address - Phone:315-431-4712
Mailing Address - Fax:315-464-2879
Practice Address - Street 1:725 IRVING AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1603
Practice Address - Country:US
Practice Address - Phone:315-464-2878
Practice Address - Fax:315-464-2879
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381994363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03076482Medicaid
NYJ400002339Medicare PIN