Healthcare Provider Details

I. General information

NPI: 1871890723
Provider Name (Legal Business Name): ANDREA AVIDANO ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 07/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SOUTH AVE BOX 58
ROCHESTER NY
14620-2733
US

IV. Provider business mailing address

1000 SOUTH AVE BOX 58
ROCHESTER NY
14620-2733
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-0209
  • Fax: 585-341-8096
Mailing address:
  • Phone: 585-341-0209
  • Fax: 585-341-8096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number305105
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number305105
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: