Provider Demographics
NPI:1245322999
Name:DEPAULIS FIUMANO, JACQUELINE CRISTINE (NP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CRISTINE
Last Name:DEPAULIS FIUMANO
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 1:3466 VAN WIE DR E
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-8910
Mailing Address - Country:US
Mailing Address - Phone:315-415-2050
Mailing Address - Fax:315-671-5791
Practice Address - Street 1:3070 BELGIUM RD
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9239
Practice Address - Country:US
Practice Address - Phone:315-671-5790
Practice Address - Fax:315-671-5791
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily