Healthcare Provider Details

I. General information

NPI: 1114005360
Provider Name (Legal Business Name): CLIFFORD J AMEDURI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 RED CREEK DR STE 120
ROCHESTER NY
14623-4273
US

IV. Provider business mailing address

400 RED CREEK DR STE 120
ROCHESTER NY
14623-4273
US

V. Phone/Fax

Practice location:
  • Phone: 585-334-5560
  • Fax: 585-334-5581
Mailing address:
  • Phone: 585-334-5560
  • Fax: 585-334-5581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number134853-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number134853-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number134853-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: