Provider Demographics
NPI:1891925319
Name:CAPPIELLO, SAMUEL CHARLES (ANP)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:CHARLES
Last Name:CAPPIELLO
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:118 DEERHURST LN APT 12
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2741
Mailing Address - Country:US
Mailing Address - Phone:585-545-9354
Mailing Address - Fax:
Practice Address - Street 1:1160 CHILI AVE STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-3035
Practice Address - Country:US
Practice Address - Phone:585-426-2990
Practice Address - Fax:585-426-4997
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304166363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health