Healthcare Provider Details

I. General information

NPI: 1821197146
Provider Name (Legal Business Name): MEGAN CIOCCA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/05/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 E HENRIETTA RD
ROCHESTER NY
14620-4629
US

IV. Provider business mailing address

435 E HENRIETTA RD
ROCHESTER NY
14620-4629
US

V. Phone/Fax

Practice location:
  • Phone: 585-760-5466
  • Fax: 585-760-5467
Mailing address:
  • Phone: 585-760-5466
  • Fax: 585-760-5467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10756
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010756
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: