Provider Demographics
NPI:1528265683
Name:FRALEY, TODD BAKER (RN)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:BAKER
Last Name:FRALEY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 JAMES ST
Mailing Address - Street 2:829
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2108
Mailing Address - Country:US
Mailing Address - Phone:315-214-5005
Mailing Address - Fax:
Practice Address - Street 1:753 JAMES ST
Practice Address - Street 2:829
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2108
Practice Address - Country:US
Practice Address - Phone:315-214-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY548445-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse