Healthcare Provider Details

I. General information

NPI: 1013426808
Provider Name (Legal Business Name): KATHLEEN A SUGRUE CNM, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MIDDLE RD
HENRIETTA NY
14467-9312
US

IV. Provider business mailing address

300 RED CREEK DR STE 100
ROCHESTER NY
14623-4283
US

V. Phone/Fax

Practice location:
  • Phone: 585-235-4860
  • Fax: 585-464-9047
Mailing address:
  • Phone: 585-922-1900
  • Fax: 585-922-0636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number001785
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421315
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: