Provider Demographics
NPI:1528152972
Name:CIPRO, COLLEEN MARY (PA-C)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:MARY
Last Name:CIPRO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:MARY
Other - Last Name:STREMPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:750 EAST ADAMS STREET
Mailing Address - Street 2:2 WEST
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-646-9648
Mailing Address - Fax:315-464-9635
Practice Address - Street 1:750 EAST ADAMS STREET
Practice Address - Street 2:2 WEST
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-646-9648
Practice Address - Fax:315-464-9635
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7740-1363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Not Answered363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical