Healthcare Provider Details

I. General information

NPI: 1801704085
Provider Name (Legal Business Name): BERANA DIVINE RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 MELVILLE ST
ROCHESTER NY
14609-5139
US

IV. Provider business mailing address

68 MELVILLE ST
ROCHESTER NY
14609-5139
US

V. Phone/Fax

Practice location:
  • Phone: 585-975-9477
  • Fax:
Mailing address:
  • Phone: 585-975-9477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number013627
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: