Healthcare Provider Details

I. General information

NPI: 1790722114
Provider Name (Legal Business Name): JEFFREY SAUNDERS TRUMBULL RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 GIBSON ST SUITE 100
CANANDAIGUA NY
14424-1340
US

IV. Provider business mailing address

185 GIBSON ST SUITE 100
CANANDAIGUA NY
14424-1340
US

V. Phone/Fax

Practice location:
  • Phone: 585-396-2863
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002051
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2051
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: