Provider Demographics
NPI:1720068356
Name:NELLI, JUDITH A (NP-C)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:NELLI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:A
Other - Last Name:NELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1001 W FAYETTE ST
Mailing Address - Street 2:STE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2859
Mailing Address - Country:US
Mailing Address - Phone:315-472-1488
Mailing Address - Fax:315-472-8060
Practice Address - Street 1:436 HINSDALE RD
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1648
Practice Address - Country:US
Practice Address - Phone:315-488-0996
Practice Address - Fax:315-488-1955
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330947363LF0000X
OHAPRN.CNP.15207363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP36414Medicare UPIN
NYP00037251Medicare PIN