Provider Demographics
NPI:1780870634
Name:DEPPOLITI, DENISE IRENE (PHD APRN BC)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:IRENE
Last Name:DEPPOLITI
Suffix:
Gender:F
Credentials:PHD APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7270 BUCKLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212
Mailing Address - Country:US
Mailing Address - Phone:315-452-0485
Mailing Address - Fax:315-452-0491
Practice Address - Street 1:7270 BUCKLEY ROAD
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212
Practice Address - Country:US
Practice Address - Phone:315-452-0485
Practice Address - Fax:315-452-0491
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231011163W00000X
NY364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult