Healthcare Provider Details

I. General information

NPI: 1891417887
Provider Name (Legal Business Name): CALEB DAVID BRANCH NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 07/22/2023
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SOUTH AVE
ROCHESTER NY
14620-2782
US

IV. Provider business mailing address

5697 BUFFALO RD
CHURCHVILLE NY
14428-9755
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-8130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number717588
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number310959
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number310959
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: