Healthcare Provider Details

I. General information

NPI: 1790312957
Provider Name (Legal Business Name): RACHEL ANNE FAZENBAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL ANNE KITT MD

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 11/27/2025
Certification Date: 11/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-1766
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 651
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2972
  • Fax: 585-461-3614
Mailing address:
  • Phone: 585-275-2972
  • Fax: 585-461-3614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number324641
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: