Healthcare Provider Details

I. General information

NPI: 1508180886
Provider Name (Legal Business Name): REBECCA A FLYNN RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVE
ROCHESTER NY
14621-3001
US

IV. Provider business mailing address

108 THISTLEDOWN DR
ROCHESTER NY
14617-3021
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-5067
  • Fax: 585-922-2908
Mailing address:
  • Phone: 585-370-0750
  • Fax: 585-922-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number013934
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: