Healthcare Provider Details

I. General information

NPI: 1063384949
Provider Name (Legal Business Name): JAMIEE CHEREESE MCCLARY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 RUGBY AVE
ROCHESTER NY
14619-1135
US

IV. Provider business mailing address

95 RUGBY AVE
ROCHESTER NY
14619-1135
US

V. Phone/Fax

Practice location:
  • Phone: 585-820-6473
  • Fax:
Mailing address:
  • Phone: 585-820-6473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number686778
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: