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NPI Code Detail

MEDICARE: INDYA DENISE JACKSON

MEDICARE: INDYA DENISE JACKSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care CoordinatorNY

General Provider Information

NPI Number : 1750223459
Entity Type Code : Individual
Provider Name (Legal Business Name) : INDYA DENISE JACKSON
Provider Business Mailing Address
First Line : 50 VANTAGE POINT DR
Second Line :
City : ROCHESTER
State : NY
Zip : 14624-1180
Country : US
Telephone Number : 585-352-7775
Fax Number : 585-352-7879
Provider Business Practice Location Address
First Line : 50 VANTAGE POINT DR
Second Line :
City : ROCHESTER
State : NY
Zip : 14624-1180
Country : US
Telephone Number : 585-352-7775
Fax Number : 585-352-7879
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2026
Last Update Date : 04/09/2026

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