Individual provider Active NPI

Roxellen Anntoinette Auletto, PNP, ANP-BC

  • Adult Health Nurse Practitioner
  • Syracuse, NY
National Provider Identifier
1083712764
Registry record updated Feb 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
26NN09572100 Issued in NJ
Practice address
174 Attack Wing
6001 E. Molloy Road
Syracuse, NY 13211
Phone
(315) 454-6146
NPI assigned
Sep 20, 2006
Last updated
Feb 13, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 26NN09572100 NJ Primary
Pediatric Nurse Practitioner 363LP0200X 26NN09572100 NJ

Addresses

Primary practice location

174 Attack Wing
6001 E. Molloy Road
Syracuse, NY 13211

Mailing address

3 N Columbus Blvd Apt Td418
Philadelphia, PA 19106-1431
Phone (707) 333-9985

Other identifiers 3

IdentifierTypeStateIssuer
233710ANGOtherNJMEDICARE PTAN
2633604MedicaidNJ
4231272OtherNJHORIZON BC BS OF NJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
309033NYMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Regional Internal Medicine Associates, PC PastSince May 4, 2021 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739404800000",
    "number": "1083712764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 N COLUMBUS BLVD APT TD418",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191061431",
            "telephone_number": "707-333-9985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 ATTACK WING",
            "address_2": "6001 E. MOLLOY ROAD",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13211",
            "telephone_number": "315-454-6146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AULETTO",
        "first_name": "ROXELLEN",
        "middle_name": "ANNTOINETTE",
        "name_prefix": "Dr.",
        "credential": "PNP, ANP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NJ",
            "license": "26NN09572100",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NJ",
            "license": "26NN09572100",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "233710ANG",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2633604",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HORIZON BC BS OF NJ",
            "identifier": "4231272",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.