Healthcare Provider Details

I. General information

NPI: 1578160800
Provider Name (Legal Business Name): LE'JON CALHOUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 BENEDICT RD
PITTSFORD NY
14534-3435
US

IV. Provider business mailing address

56 SCARBOROUGH PARK
ROCHESTER NY
14625-1365
US

V. Phone/Fax

Practice location:
  • Phone: 585-334-6000
  • Fax:
Mailing address:
  • Phone: 585-309-1875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number339472-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: