Provider Demographics
NPI:1982313656
Name:PLADOCOSTANTE, GABRIELLA AUTUMN
Entity Type:Individual
Prefix:MS
First Name:GABRIELLA
Middle Name:AUTUMN
Last Name:PLADOCOSTANTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6303
Mailing Address - Country:US
Mailing Address - Phone:315-798-1832
Mailing Address - Fax:315-798-1432
Practice Address - Street 1:117 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6303
Practice Address - Country:US
Practice Address - Phone:315-798-1832
Practice Address - Fax:315-798-1432
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029327363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical