Healthcare Provider Details

I. General information

NPI: 1154488161
Provider Name (Legal Business Name): CHRISTINA EADIE TADDEO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 LINDEN OAKS SUITE 200
ROCHESTER NY
14625-2814
US

IV. Provider business mailing address

360 LINDEN OAKS SUITE 200
ROCHESTER NY
14625-2814
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-8315
  • Fax: 585-922-6290
Mailing address:
  • Phone: 585-922-8315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number247122
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number247122
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: