Healthcare Provider Details

I. General information

NPI: 1245151869
Provider Name (Legal Business Name): ELLA DOAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 COULTER RD STE 1630
CLIFTON SPRINGS NY
14432-1122
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 315-462-1495
  • Fax: 315-462-2003
Mailing address:
  • Phone: 585-922-1970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number036633
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: