Healthcare Provider Details

I. General information

NPI: 1326045592
Provider Name (Legal Business Name): AMANDA SOGN KNAPP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2005
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 EAST RIDGE ROAD
ROCHESTER NY
14621
US

IV. Provider business mailing address

809 EAST RIDGE ROAD
ROCHESTER NY
14621
US

V. Phone/Fax

Practice location:
  • Phone: 585-225-2525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number235040
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: