Healthcare Provider Details

I. General information

NPI: 1972407971
Provider Name (Legal Business Name): JENNIFER CONDE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 DAYLILLY LN
ROCHESTER NY
14626-4716
US

IV. Provider business mailing address

81 DAYLILLY LN
ROCHESTER NY
14626-4716
US

V. Phone/Fax

Practice location:
  • Phone: 585-690-6862
  • Fax:
Mailing address:
  • Phone: 585-690-6862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number641251
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: