Healthcare Provider Details

I. General information

NPI: 1740244649
Provider Name (Legal Business Name): MARY JO SPALLINA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 09/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CANAL VIEW BLVD SUITE 400
ROCHESTER NY
14623
US

IV. Provider business mailing address

777 CANAL VIEW BLVD SUITE 400
ROCHESTER NY
14623
US

V. Phone/Fax

Practice location:
  • Phone: 585-244-3430
  • Fax: 585-244-2202
Mailing address:
  • Phone: 585-244-3430
  • Fax: 585-244-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF001001-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: