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Provider Information for 1578162624

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1578162624

Calendar   Last Updated:  2020-12-18
  Certification Date:  2020-12-18


Name Value
NPI 1578162624
Enumeration Date 2020-10-20
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 100 KINGS HWY S
ROCHESTER, NY 14617-5504
United States

Phone: 585-690-1153 | Fax:
View Map External Link
Primary Practice Address 2655 RIDGEWAY AVE
ROCHESTER, NY 14626-4296
United States

Phone: 585-723-7972 | Fax:
View Map External Link
Secondary Practice Address 50 MIDDLE RD
HENRIETTA, NY 14467-9312
United States

Phone: 585-723-7972 | Fax: 585-368-3119
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 363AM0700X - Physician Assistant Medical NY 025170