Healthcare Provider Details

I. General information

NPI: 1114996543
Provider Name (Legal Business Name): JEANNE SOLEILLE L. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 EAST AVE SUITE 104
ROCHESTER NY
14607-2152
US

IV. Provider business mailing address

1370 EAST AVE APT. 8
ROCHESTER NY
14610-1651
US

V. Phone/Fax

Practice location:
  • Phone: 585-461-1603
  • Fax: 585-461-1603
Mailing address:
  • Phone: 585-461-1603
  • Fax: 585-461-1603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0000565
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: