Individual
CARLY DETOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
104 UNION AVE, SUITE 1001-1002, SYRACUSE, NY 13203-1843
(315) 423-7192
(315) 423-8013
Mailing address
104 UNION AVE, SUITE 1001-1002, SYRACUSE, NY 13203-1843
(315) 423-7192
(315) 423-8013
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
339796
NY
Other
Enumeration date
07/30/2015
Last updated
07/30/2015
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