Healthcare Provider Details

I. General information

NPI: 1245427095
Provider Name (Legal Business Name): ERIKA KRISTIN VENNIRO RPAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 07/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX SURG
ROCHESTER NY
14642-8410
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 675
ROCHESTER NY
14642
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2876
  • Fax: 585-276-1992
Mailing address:
  • Phone: 585-275-7753
  • Fax: 585-461-0662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number12021
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number012021
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: