Healthcare Provider Details

I. General information

NPI: 1588282750
Provider Name (Legal Business Name): AMY CHENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY DELUCA

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 N MAIN ST
CANANDAIGUA NY
14424-1033
US

IV. Provider business mailing address

191 REDON CIR
WEBSTER NY
14580-3710
US

V. Phone/Fax

Practice location:
  • Phone: 585-394-7930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI065377
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: