Healthcare Provider Details

I. General information

NPI: 1639284003
Provider Name (Legal Business Name): CHINYERE IDARA AMADI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 GENESEE ST
ROCHESTER NY
14611-3201
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-3531
  • Fax: 585-368-3767
Mailing address:
  • Phone: 585-922-5462
  • Fax: 585-922-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA91346
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number259001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: