Healthcare Provider Details

I. General information

NPI: 1538054341
Provider Name (Legal Business Name): EMILY SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SOUTH AVE
ROCHESTER NY
14620-2733
US

IV. Provider business mailing address

6304 ISLAND RD
CICERO NY
13039-9375
US

V. Phone/Fax

Practice location:
  • Phone: 585-473-2200
  • Fax:
Mailing address:
  • Phone: 315-404-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF312302-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: