Healthcare Provider Details

I. General information

NPI: 1487249728
Provider Name (Legal Business Name): LUNDY FENTI CRPA-P, NYSCRS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 12/21/2025
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 EAST ST APT 205
CANANDAIGUA NY
14424-1372
US

IV. Provider business mailing address

2650 EAST ST APT 205
CANANDAIGUA NY
14424-1372
US

V. Phone/Fax

Practice location:
  • Phone: 585-406-3749
  • Fax:
Mailing address:
  • Phone: 585-406-3749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: