Healthcare Provider Details

I. General information

NPI: 1619894656
Provider Name (Legal Business Name): JACQUELINE MARIE DUMMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 EAST AVE STE 100
ROCHESTER NY
14604-2699
US

IV. Provider business mailing address

175 ALEXANDER ST APT 319
ROCHESTER NY
14607-3669
US

V. Phone/Fax

Practice location:
  • Phone: 585-325-5100
  • Fax: 585-325-5154
Mailing address:
  • Phone: 585-325-5100
  • Fax: 585-325-5154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCRPA-P-8340
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: