MEDICARE: MCKAYLLE JEAN WOODCOCK PA-C

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	028664	NY

General Provider Information

NPI Number	:	1205564416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKAYLLE JEAN WOODCOCK PA-C

Provider Business Mailing Address
First Line	:	995 SENATOR KEATING BLVD.
Second Line	:	BLDG E, SUITE 200
City	:	ROCHESTER
State	:	NY
Zip	:	14618-2776
Country	:	US
Telephone Number	:	585-602-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	995 SENATOR KEATING BLVD.
Second Line	:	BLDG E, SUITE 200
City	:	ROCHESTER
State	:	NY
Zip	:	14618-2776
Country	:	US
Telephone Number	:	585-602-0500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2022
Last Update Date	:	10/09/2023

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