Healthcare Provider Details

I. General information

NPI: 1154705192
Provider Name (Legal Business Name): FINGER LAKES UNITED CEREBRAL PALSY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2015
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5415 N BLOOMFIELD RD
CANANDAIGUA NY
14424-7964
US

IV. Provider business mailing address

5415 N BLOOMFIELD RD
CANANDAIGUA NY
14424-7964
US

V. Phone/Fax

Practice location:
  • Phone: 585-394-9510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DARRELL JAMES WHITBECK
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 585-334-6000