Healthcare Provider Details

I. General information

NPI: 1316504582
Provider Name (Legal Business Name): MICHELLE LEE CRYE HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ELMWOOD AVE STE 400
ROCHESTER NY
14620-3042
US

IV. Provider business mailing address

1000 ELMWOOD AVE STE 400
ROCHESTER NY
14620-3092
US

V. Phone/Fax

Practice location:
  • Phone: 585-271-0680
  • Fax: 585-442-4114
Mailing address:
  • Phone: 585-271-0680
  • Fax: 585-442-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number14000032700
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: