Provider Demographics
NPI:1437143575
Name:IAFALLO, DEBORAH L (ANP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:IAFALLO
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4553 WINDING WOODS LN
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5453
Mailing Address - Country:US
Mailing Address - Phone:716-648-7112
Mailing Address - Fax:
Practice Address - Street 1:4553 WINDING WOODS LN
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5453
Practice Address - Country:US
Practice Address - Phone:716-648-7112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304130363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02639518Medicaid