Provider Demographics
NPI:1184923112
Name:CECCHETTO, KATE RYAN (RPA-C)
Entity type:Individual
Prefix:MS
First Name:KATE
Middle Name:RYAN
Last Name:CECCHETTO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 E MAIN ST STE 700
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2916
Mailing Address - Country:US
Mailing Address - Phone:631-361-4802
Mailing Address - Fax:631-361-5376
Practice Address - Street 1:290 E MAIN ST STE 700
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-361-5302
Practice Address - Fax:631-361-5376
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014654363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant