Healthcare Provider Details

I. General information

NPI: 1982968475
Provider Name (Legal Business Name): LEAH MARIE TIRABASSI MS ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 RIDGE RD
WEBSTER NY
14580-2449
US

IV. Provider business mailing address

766 RIDGE RD
WEBSTER NY
14580-2449
US

V. Phone/Fax

Practice location:
  • Phone: 585-797-9366
  • Fax: 585-486-1230
Mailing address:
  • Phone: 585-797-9366
  • Fax: 585-486-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number811583
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: