Healthcare Provider Details

I. General information

NPI: 1164451654
Provider Name (Legal Business Name): JOELLE L KRAFT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/22/2023
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 S MAIN ST STE 3
CANANDAIGUA NY
14424-2208
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 665
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-5321
  • Fax:
Mailing address:
  • Phone: 585-275-5321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number007113
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number7113
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: