Healthcare Provider Details

I. General information

NPI: 1144915737
Provider Name (Legal Business Name): ANDREA ROSE DONOFRIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 NORTH ST
GENEVA NY
14456-1651
US

IV. Provider business mailing address

196 NORTH ST
GENEVA NY
14456-1651
US

V. Phone/Fax

Practice location:
  • Phone: 315-787-4000
  • Fax:
Mailing address:
  • Phone: 315-787-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number340488
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: