Healthcare Provider Details

I. General information

NPI: 1144786765
Provider Name (Legal Business Name): MICHELLE GIANNETTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 EMPIRE BLVD # 221
WEBSTER NY
14580-1934
US

IV. Provider business mailing address

6 TROTTER DR
HENRIETTA NY
14467-9725
US

V. Phone/Fax

Practice location:
  • Phone: 585-317-2863
  • Fax:
Mailing address:
  • Phone: 585-317-2863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number643811
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: