Individual
CARLY ELLEN CANAVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1499 NEW SCOTLAND RD, SLINGERLANDS, NY 12159-9209
(518) 320-7517
Mailing address
96 LIPTON ST, KINGSTON, NY 12401-1814
(845) 389-6644
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
025220
NY
Other
Enumeration date
07/16/2020
Last updated
07/16/2020
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