Healthcare Provider Details

I. General information

NPI: 1073784161
Provider Name (Legal Business Name): PAMELA TUNNEY KRUGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 S CLINTON AVE STE 200
ROCHESTER NY
14618-2663
US

IV. Provider business mailing address

2365 S CLINTON AVE STE 200
ROCHESTER NY
14618-2663
US

V. Phone/Fax

Practice location:
  • Phone: 585-758-5700
  • Fax: 585-758-1297
Mailing address:
  • Phone: 585-758-5700
  • Fax: 585-758-1297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number002451-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: