Provider Information for 1265874770
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Ms. SHANELLE L SLADE
Sex: Female
NPI: 1265874770
Last Updated: 2017-02-24
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1265874770 | ||||||||||||
| Enumeration Date | 2013-07-25 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 132 EARL ST ROCHESTER, NY 14611-3730 United States Phone: 585-957-1166 | Fax: | ||||||||||||
| Primary Practice Address | 224 ALEXANDER ST ROCHESTER, NY 14607-4000 United States Phone: 585-922-7784 | Fax: | ||||||||||||
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