Healthcare Provider Details

I. General information

NPI: 1508599150
Provider Name (Legal Business Name): AMANDA FLOTTERON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S CLINTON AVE BLDG G
ROCHESTER NY
14618-2668
US

IV. Provider business mailing address

495 WESTCHESTER AVE
ROCHESTER NY
14609-4526
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-4775
  • Fax:
Mailing address:
  • Phone: 585-734-6412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number28437
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number028437
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: