Dustin John Fanciullo
Vascular Surgeon
1445 Portland Ave Suite 108
Rochester
, New York 14621-3036
Dustin John Fanciullo
Vascular Surgeon
1445 Portland Ave Suite 108
Rochester
, New York 14621-3036
(585) 922-0450
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About
Features
Specialties
- Vascular Surgeon
Languages spoken
- English
Location
First Address
- Dustin John Fanciullo
- 1445 Portland Ave Suite 108
- Rochester, NY
- Zip : 14621-3036
- Fax : (585) 922-0450
- Phone : (585) 922-5550
Second Address
- Dustin John Fanciullo
- 1445 Portland Ave Suite 108
- Rochester, NY
- Zip : 14621-3036
- Fax : (585) 922-0450
- Phone : (585) 922-5550
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2086S0129X | Vascular Surgeon | 252553-1 | NY |
National Provider Identifier
| NPI | 1013164052 |
|---|---|
| Provider Name | Dustin John Fanciullo |
| First Address | Rochester, NY 14621-3036 |
| Second Address | Rochester, NY 14621-3036 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 21/08/2008 |
| Last Update Date | 22/05/2020 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.