Provider Demographics
NPI:1053325100
Name:CAVELLI, RACHAEL LOUISE (NP)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LOUISE
Last Name:CAVELLI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4939 BRITTONFIELD PKWY
Mailing Address - Street 2:CNY FAMILY CARE
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9208
Mailing Address - Country:US
Mailing Address - Phone:315-463-1600
Mailing Address - Fax:315-634-6766
Practice Address - Street 1:4939 BRITTONFIELD PKWY
Practice Address - Street 2:CNY FAMILY CARE
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9208
Practice Address - Country:US
Practice Address - Phone:315-463-1600
Practice Address - Fax:315-634-6766
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333219363L00000X
NC217149363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P71986Medicare UPIN
DD3066Medicare ID - Type Unspecified