Individual
REBECCA RISEWICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4900 BROAD RD, SYRACUSE, NY 13215-2265
(315) 492-5011
Mailing address
8152 MANTOVA DR, CLAY, NY 13041-9106
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
021265-1
NY
Other
Enumeration date
11/05/2017
Last updated
10/22/2025
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