MEDICARE: JESSICA KURZDORFER NURSE PRACTITIONER IN PSYCHIATRY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QC1500X	Community Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1063094688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSICA KURZDORFER NURSE PRACTITIONER IN PSYCHIATRY PC

Provider Business Mailing Address
First Line	:	59 ROWLEY ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14607-2630
Country	:	US
Telephone Number	:	585-360-7554
Fax Number	:	949-577-4708

Provider Business Practice Location Address
First Line	:	95 ALLENS CREEK RD STE 330
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-3246
Country	:	US
Telephone Number	:	585-360-7554
Fax Number	:	949-577-4708

Authorized Official
Title or Position	:	NURSE PRACTITIONER/PRESIDENT
Name	:	SEAN KURZDORFER
Credential	:	PMHNP
Telephone Number	:	585-360-7554

Provider Enumeration Date	:	04/23/2021
Last Update Date	:	12/12/2024

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