1316222912 NPI number — CHELSEA SAUVE CARNIE PA

Table of content: MRS. AMY E OGRADY CRNP (NPI 1265405591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316222912 NPI number — CHELSEA SAUVE CARNIE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARNIE
Provider First Name:
CHELSEA
Provider Middle Name:
SAUVE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAUVE
Provider Other First Name:
CHELSEA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316222912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3516 W LAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANLIUS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13104-9682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-593-8550
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
736 IRVING AVE
Provider Second Line Business Practice Location Address:
CROUSE HOSPITAL ED
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-1687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-470-7308
Provider Business Practice Location Address Fax Number:
315-470-2693
Provider Enumeration Date:
10/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  016478-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 0010-03141 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PENDING , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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