Healthcare Provider Details

I. General information

NPI: 1407461221
Provider Name (Legal Business Name): DANIELLE MARIE LAZZARO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CARTER ST
ROCHESTER NY
14621-2604
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-4173
  • Fax: 585-922-5595
Mailing address:
  • Phone: 585-922-4173
  • Fax: 585-922-5595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346348
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: