Healthcare Provider Details

I. General information

NPI: 1467715599
Provider Name (Legal Business Name): MRS. CINDY MARIE MIZERNY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 SAINT PAUL ST
ROCHESTER NY
14605-1706
US

IV. Provider business mailing address

691 SAINT PAUL ST
ROCHESTER NY
14605-1706
US

V. Phone/Fax

Practice location:
  • Phone: 585-753-5265
  • Fax: 585-324-1750
Mailing address:
  • Phone: 585-753-5265
  • Fax: 585-324-1750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: