Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Peter Anthony Fedullo, PA

Individual provider Surgical Physician Assistant · NPI 1275833931

Mr. Peter Anthony Fedullo, PA is a Surgical Physician Assistant in New York, New York. Licensed in New York. Registered with an NPI since 2010.

Licensed in
NY
In the registry since
2010
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

622 W 168th St
New York, NY 10032-3720
Phone: (212) 305-2500
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 014433 (NY)

Record details

NPI number1275833931
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedOctober 28, 2010
Last updated in NPPESOctober 28, 2010

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