Healthcare Provider Details

I. General information

NPI: 1194356857
Provider Name (Legal Business Name): LYUDMILA KUCHMA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 PORTLAND AVE STE 350
ROCHESTER NY
14621-3043
US

IV. Provider business mailing address

1415 PORTLAND AVE STE 350
ROCHESTER NY
14621-3043
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-5320
  • Fax:
Mailing address:
  • Phone: 585-442-5320
  • Fax: 585-442-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberF431672-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number431673
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: