Healthcare Provider Details

I. General information

NPI: 1760764682
Provider Name (Legal Business Name): CASIA JOYCE WHITNEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASIA JOYCE MOFFATT PA

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 01/26/2025
Certification Date: 01/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 E RIDGE RD
ROCHESTER NY
14622-2448
US

IV. Provider business mailing address

1850 E RIDGE RD
ROCHESTER NY
14622-2448
US

V. Phone/Fax

Practice location:
  • Phone: 585-342-3870
  • Fax: 585-342-7938
Mailing address:
  • Phone: 585-342-3870
  • Fax: 585-342-7938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number015120
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: