Provider Demographics
NPI:1689617136
Name:DIDONATO, KATHLEEN P (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:P
Last Name:DIDONATO
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 1:124 RUGBY RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-3225
Mailing Address - Country:US
Mailing Address - Phone:315-437-1693
Mailing Address - Fax:315-437-1831
Practice Address - Street 1:124 RUGBY RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-3225
Practice Address - Country:US
Practice Address - Phone:315-437-1693
Practice Address - Fax:315-437-1831
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340373363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03118307Medicaid
NYJ400005483Medicare PIN