Healthcare Provider Details

I. General information

NPI: 1649572801
Provider Name (Legal Business Name): KAYLA R FAZI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2010
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 MIA TER
ROCHESTER NY
14624-4453
US

IV. Provider business mailing address

481 FRENCH RD
ROCHESTER NY
14618-5374
US

V. Phone/Fax

Practice location:
  • Phone: 585-698-8569
  • Fax:
Mailing address:
  • Phone: 585-698-8569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number673786
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: