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NPI Code Detail

MEDICARE: MARISSA R GALLO CRNA

MEDICARE: MARISSA R GALLO CRNA
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
1367500000XCertified Registered Nurse Anesthetist672769NY

General Provider Information

NPI Number : 1770166837
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISSA R GALLO CRNA
Provider Business Mailing Address
First Line : 100 KINGS HWY S
Second Line :
City : ROCHESTER
State : NY
Zip : 14617-5504
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1555 LONG POND RD
Second Line :
City : ROCHESTER
State : NY
Zip : 14626-4164
Country : US
Telephone Number : 585-723-7191
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2021
Last Update Date : 12/08/2025

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Directions to “ MARISSA R GALLO CRNA” Practice Location

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