Healthcare Provider Details

I. General information

NPI: 1366183428
Provider Name (Legal Business Name): HEATHER SPECK MENDIZABAL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER SPECK DO

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LATTIMORE RD STE 280
ROCHESTER NY
14620-4157
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 635
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-276-6455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number346396
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: