Provider Demographics
NPI:1861089146
Name:RONDENELLI, MICHAEL (FNP-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RONDENELLI
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 LUECK LN
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-6115
Mailing Address - Country:US
Mailing Address - Phone:315-272-9361
Mailing Address - Fax:
Practice Address - Street 1:3504 W GENESEE ST STE 1B
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-2012
Practice Address - Country:US
Practice Address - Phone:315-401-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF346529-01363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care