Healthcare Provider Details

I. General information

NPI: 1841153954
Provider Name (Legal Business Name): BRITNY BLAKE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BERRY ST
ROCHESTER NY
14609-7121
US

IV. Provider business mailing address

10 BERRY ST
ROCHESTER NY
14609-7121
US

V. Phone/Fax

Practice location:
  • Phone: 585-710-0424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberN11577
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: