Healthcare Provider Details

I. General information

NPI: 1063820645
Provider Name (Legal Business Name): CHRISTINE VIEIRA PSYCHIATRIC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE DEFRANCO PSYCHIATRIC NP

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1892 RIDGE RD
ONTARIO NY
14519-9547
US

IV. Provider business mailing address

1892 RIDGE RD
ONTARIO NY
14519-9547
US

V. Phone/Fax

Practice location:
  • Phone: 585-414-4802
  • Fax:
Mailing address:
  • Phone: 585-414-4802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF403931-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number687546
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: