Healthcare Provider Details

I. General information

NPI: 1679689525
Provider Name (Legal Business Name): JUDY ANN D'ANGELO ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX 619
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

80 BRANDYWINE LN
ROCHESTER NY
14618-5602
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-3933
  • Fax:
Mailing address:
  • Phone: 585-271-7014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF304049-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: