Provider Demographics
NPI:1851416762
Name:CIRILLO, PATTI A (RN,NP)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:A
Last Name:CIRILLO
Suffix:
Gender:F
Credentials:RN,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13495-1724
Mailing Address - Country:US
Mailing Address - Phone:315-736-4602
Mailing Address - Fax:
Practice Address - Street 1:301 N WASHINGTON ST STE 2470
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1299
Practice Address - Country:US
Practice Address - Phone:315-867-1465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255247-1163WP0809X
NY401027363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY300396Medicaid
NY300396Medicaid