Healthcare Provider Details

I. General information

NPI: 1245653088
Provider Name (Legal Business Name): SUSAN AZZOLINO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 08/03/2025
Certification Date: 08/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LINDEN OAKS STE 200
ROCHESTER NY
14625-2831
US

IV. Provider business mailing address

30 CROSS GATES RD
ROCHESTER NY
14606-3307
US

V. Phone/Fax

Practice location:
  • Phone: 585-586-1600
  • Fax: 585-586-7951
Mailing address:
  • Phone: 585-465-2076
  • Fax: 585-360-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number535933
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401891
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: