Healthcare Provider Details

I. General information

NPI: 1649852773
Provider Name (Legal Business Name): FREDERICK MBUYEE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 POWERS LN
ROCHESTER NY
14624-4405
US

IV. Provider business mailing address

187 POWERS LN
ROCHESTER NY
14624-4405
US

V. Phone/Fax

Practice location:
  • Phone: 585-355-6058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number765409
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: