Healthcare Provider Details

I. General information

NPI: 1275792210
Provider Name (Legal Business Name): PAMELA ROUX NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4887 STATE ROUTE 96A
ROMULUS NY
14541-9767
US

IV. Provider business mailing address

4887 STATE ROUTE 96A
ROMULUS NY
14541-9767
US

V. Phone/Fax

Practice location:
  • Phone: 315-585-3062
  • Fax:
Mailing address:
  • Phone: 315-585-3062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number445780
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF381555
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401486
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: