Provider Demographics
NPI:1538895313
Name:RASTANI, CAITLIN (FNP)
Entity type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:
Last Name:RASTANI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6593 MALLORY RD
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6707
Mailing Address - Country:US
Mailing Address - Phone:315-794-3799
Mailing Address - Fax:
Practice Address - Street 1:268 GENESEE ST STE B1
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4617
Practice Address - Country:US
Practice Address - Phone:315-801-7140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349924363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily