Healthcare Provider Details

I. General information

NPI: 1356953798
Provider Name (Legal Business Name): LIVING HOPE LACTATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 NORTH GOODMAN STREET STE 1
ROCHESTER NY
14609-1460
US

IV. Provider business mailing address

62 WILLMONT ST
ROCHESTER NY
14609-3620
US

V. Phone/Fax

Practice location:
  • Phone: 585-738-2507
  • Fax: 585-673-7260
Mailing address:
  • Phone: 585-738-2507
  • Fax: 585-673-7260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: SHARON ANN REILLY
Title or Position: LACTATION COUNSELOR
Credential: RN BSN IBCLC
Phone: 585-738-2507