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NPI Code Detail

MEDICARE: APRYL N AMO JACKSON

MEDICARE: APRYL N AMO JACKSON
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
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1760798987
Entity Type Code : Individual
Provider Name (Legal Business Name) : APRYL N AMO JACKSON
Provider Business Mailing Address
First Line : 3500 MIDDLE CHESHIRE RD
Second Line :
City : CANANDAIGUA
State : NY
Zip : 14424-2466
Country : US
Telephone Number : 585-905-4185
Fax Number :
Provider Business Practice Location Address
First Line : 3255 BRIGHTON HENRIETTA TOWN LINE RD
Second Line : SUITE 102
City : ROCHESTER
State : NY
Zip : 14623-2806
Country : US
Telephone Number : 585-427-7610
Fax Number : 585-427-7410
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2010
Last Update Date : 08/25/2010

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