Healthcare Provider Details

I. General information

NPI: 1720220924
Provider Name (Legal Business Name): VALERIE MARIA ROZAK BRUNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVENUE BOX 228
ROCHESTER NY
14621
US

IV. Provider business mailing address

1425 PORTLAND AVENUE BOX 228
ROCHESTER NY
14621
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-2575
  • Fax:
Mailing address:
  • Phone: 585-922-2575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number266200-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: