Healthcare Provider Details

I. General information

NPI: 1902662018
Provider Name (Legal Business Name): VAMPLIFE LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 LONG POND RD UNIT SUITE205
ROCHESTER NY
14626-5002
US

IV. Provider business mailing address

653 FLOWER CITY PARK
ROCHESTER NY
14615-3620
US

V. Phone/Fax

Practice location:
  • Phone: 315-333-0710
  • Fax:
Mailing address:
  • Phone: 351-333-0710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROLANDA STEVENS
Title or Position: CO OWNER
Credential: PBT (ASCP)
Phone: 315-333-0710