Healthcare Provider Details

I. General information

NPI: 1043836869
Provider Name (Legal Business Name): SHARON ANN REILLY RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 NORTH GOODMAN STREET SUITE 1
ROCHESTER NY
14609
US

IV. Provider business mailing address

910 NORTH GOODMAN STREET SUITE 1
ROCHESTER NY
14609
US

V. Phone/Fax

Practice location:
  • Phone: 585-738-2507
  • Fax:
Mailing address:
  • Phone: 585-738-2507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-161927
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number318900-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: