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General NPI Number Information
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NPI Number | 1972743326
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Entity Type | Organization
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Legal Business Name | SHADEFAI GOLDSMITH
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Dates
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Enumeration Date | 02/25/2009
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Last Update Date | 06/14/2012
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Provider Practice Location Address
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Address Line | 929 RIDGEWAY AVE
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City | ROCHESTER
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State | NY
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Zip | 14615-3824
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Country | US
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Telephone | 585-734-4484
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Fax |
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Provider Business Mailing Address
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Address Line | 929 RIDGEWAY AVE
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City | ROCHESTER
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State | NY
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Zip | 14615-3824
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Country | US
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Telephone | 585-734-4484
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Fax |
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Authorized Official
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Title or Position | LICENSED PRACTICAL NURSE
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Name | MS. SHADEFAI ZSALINN GOLDSMITH
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Credential |
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Telephone | 585-413-3762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 295552
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License Number State | NY
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