Healthcare Provider Details

I. General information

NPI: 1316464563
Provider Name (Legal Business Name): JONNA M ZELIE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JONNA SCHAPER

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 06/29/2023
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LATTIMORE RD STE G-110
ROCHESTER NY
14620-4159
US

IV. Provider business mailing address

395 WEST AVE STE 700
CANANDAIGUA NY
14424-1548
US

V. Phone/Fax

Practice location:
  • Phone: 585-486-0930
  • Fax:
Mailing address:
  • Phone: 585-486-0901
  • Fax: 585-940-5399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number021278
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number21278
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: