Healthcare Provider Details

I. General information

NPI: 1245523786
Provider Name (Legal Business Name): AMADU BARRY LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PRIVET WAY
ROCHESTER NY
14624-5546
US

IV. Provider business mailing address

201 PRIVET WAY
ROCHESTER NY
14624-5546
US

V. Phone/Fax

Practice location:
  • Phone: 585-527-8294
  • Fax:
Mailing address:
  • Phone: 585-527-8294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number294549-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: