Stephen Michael Nellis, PT
Individual provider Active NPI Specialist · Canastota, NY
NPI 1508948167 · NPPES record last updated Oct 29, 2019
Key facts
- NPI
- 1508948167
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 17733 (NY)
- Practice address
- 3400 Seneca Tpke Ste 7
Canastota, NY 13032-4632 - Phone
- (315) 697-8514
- Fax
- (315) 697-8147
- NPI assigned
- Oct 20, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17733 | NY | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 17733 | NY | Yes |
Addresses
Primary practice location
3400 Seneca Tpke Ste 7
Canastota, NY 13032-4632
Mailing address
207 Pine St
Syracuse, NY 13210-1137
Phone (315) 476-3176
Other providers in Canastota, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.