Healthcare Provider Details

I. General information

NPI: 1649187899
Provider Name (Legal Business Name): DORIS KIRBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 YARMOUTH RD
ROCHESTER NY
14610-1944
US

IV. Provider business mailing address

261 LINCOLN ST APT 1
WORCESTER MA
01605-2169
US

V. Phone/Fax

Practice location:
  • Phone: 332-217-8417
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR25129500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN10037241
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number874559-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: