Healthcare Provider Details

I. General information

NPI: 1699808048
Provider Name (Legal Business Name): COLLEEN M DEUEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 36 SONYEA ROAD STATE OF NEW YORK DEPT HEALTH
SONYEA NY
14556-0049
US

IV. Provider business mailing address

PO BOX 49 ROUTE 36 SONYEA ROAD
SONYEA NY
14556-0049
US

V. Phone/Fax

Practice location:
  • Phone: 585-658-3710
  • Fax:
Mailing address:
  • Phone: 585-658-3710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number215493
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: