Provider Demographics
NPI:1902827314
Name:FASANELLO, VINCENT JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JOSEPH
Last Name:FASANELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:135 SULLYS TRL
Mailing Address - Street 2:STE 11
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4564
Mailing Address - Country:US
Mailing Address - Phone:585-381-1558
Mailing Address - Fax:585-381-0109
Practice Address - Street 1:135 SULLYS TRL
Practice Address - Street 2:STE 11
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-4564
Practice Address - Country:US
Practice Address - Phone:585-381-1558
Practice Address - Fax:585-381-0109
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1706352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101190EUOtherPREFERRED CARE
NY010176035OtherBLUE CHOICE
NY5714454OtherAETNA
NY1745OtherBLUE CROSS BLUE SHIELD
NY101190EUOtherPREFERRED CARE
NY1745OtherBLUE CROSS BLUE SHIELD