Individual
DR. SEBASTIAN SALVATORE FASANELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
150 MARTIN RD, LACKAWANNA, NY 14218-2708
(716) 828-9811
(716) 828-9363
Mailing address
150 MARTIN RD, LACKAWANNA, NY 14218-2708
(716) 828-9811
(716) 828-9363
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
090320
NY
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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