Provider Demographics
NPI:1093441933
Name:NADEAU, PEYTON ELIZABETH
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:ELIZABETH
Last Name:NADEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 SPARHAWK RD
Mailing Address - Street 2:
Mailing Address - City:PARISH
Mailing Address - State:NY
Mailing Address - Zip Code:13131-3145
Mailing Address - Country:US
Mailing Address - Phone:315-935-0001
Mailing Address - Fax:
Practice Address - Street 1:261 SPARHAWK RD
Practice Address - Street 2:
Practice Address - City:PARISH
Practice Address - State:NY
Practice Address - Zip Code:13131-3145
Practice Address - Country:US
Practice Address - Phone:315-935-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2255A2300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer