Healthcare Provider Details

I. General information

NPI: 1295491413
Provider Name (Legal Business Name): JOCELYN DE ASIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 E RIDGE RD STE 20
ROCHESTER NY
14621-1239
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-0400
  • Fax: 585-922-0455
Mailing address:
  • Phone: 585-922-0400
  • Fax: 585-922-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number310527
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number310527
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: