Individual
DUSTIN JOHN FANCIULLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
14267138-1205
UT
208600000X
Surgery Physician
252553
NY
2086S0129X
Vascular Surgery Physician
Primary
14267138-1205
UT
2086S0129X
Vascular Surgery Physician
Primary
252553-1
NY
Other
Enumeration date
08/21/2008
Last updated
03/02/2026
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