Healthcare Provider Details

I. General information

NPI: 1730695917
Provider Name (Legal Business Name): MR. JAMES ABOAGYE BUDU SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2017
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CRITTENDEN BLVD.
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

300 CRITTENDEN BLVD BOX PSYCH
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-273-1739
  • Fax: 585-276-0067
Mailing address:
  • Phone: 585-273-1739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number724470-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number404512
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: