Healthcare Provider Details

I. General information

NPI: 1154981116
Provider Name (Legal Business Name): MADELEINE JANINE DIEGIDIO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 07/03/2023
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE # 679-B
ROCHESTER NY
14642-0001
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number431510
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number431510
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: