Healthcare Provider Details

I. General information

NPI: 1346948288
Provider Name (Legal Business Name): MS. CAMRYN ASHLEIGH CORTEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CANAL LANDING BLVD STE 1
ROCHESTER NY
14626-5107
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-4050
  • Fax: 585-723-6705
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number032672
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: