Healthcare Provider Details

I. General information

NPI: 1760799852
Provider Name (Legal Business Name): BECCA SPAULDING NPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BECCA MCNAMARA NPP

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 E RIDGE RD
ROCHESTER NY
14621-1229
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-2500
  • Fax:
Mailing address:
  • Phone: 585-922-4394
  • Fax: 585-922-5715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number400509
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: