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General NPI Number Information
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NPI Number | 1003918400
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Entity Type | Individual
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Provider Name | SUE E. STALEY
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Gender | Female
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 12/13/2013
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Provider Practice Location Address
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Address Line | 350 PARRISH ST
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1731
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Country | US
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Telephone | 585-396-6071
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Fax |
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Provider Business Mailing Address
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Address Line | 410 RYAN WAY
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City | AVON
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State | NY
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Zip | 14414-1462
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Country | US
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Telephone | 585-438-4048
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F302271
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License Number State | NY
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