MARC GAUDETTE (NPI# 1558398321) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558398321 |
| Entity Type | Individual |
| Full Name | MARC GAUDETTE |
| Credential | PH D |
| Practice Address |
2655 Ridgeway Ave Suite 420 Rochester NY 14626-4285 |
| Practice Telephone | 5857237972 |
| Practice Fax Number | 5853683119 |
| Mailing Telephone | 5857237972 |
| Mailing Fax Number | 5853683119 |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2015-03-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | 011956 | NY | Behavioral Health & Social Service Providers |
| N | 103T00000X | Psychologist | 011956 | NY | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 02307028 | 05 |
| Street Address |
2655 RIDGEWAY AVE SUITE 420 |
| City | ROCHESTER |
| State | NY |
| Zip Code | 14626-4285 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316944812 | Debra Roy Keller | Physician Assistant | 2655 Ridgeway Ave, Suite 180, Rochester, NY 14626-4296 | 2005-06-30 |
| 1578162624 | Amanda Rose Green | Physician Assistant | 2655 Ridgeway Ave, Rochester, NY 14626-4296 | 2020-10-20 |
| 1487290318 | Scott Gogstetter | Physical Therapist | 2655 Ridgeway Ave, Rochester, NY 14626-4296 | 2019-11-26 |
| 1033755178 | Colleen Marie Mitrano | Physical Therapist | 2655 Ridgeway Ave, Rochester, NY 14626-4296 | 2019-11-25 |
| 1396381018 | Diana L Hauman | Occupational Therapist | 2655 Ridgeway Ave, Rochester, NY 14626-4296 | 2019-11-19 |
| 1144772328 | Olufolake Lukula | Nurse Practitioner | 2655 Ridgeway Ave, Suite 440, Rochester, NY 14626-4296 | 2016-11-03 |
| 1073970372 | Katharine R Wilson | Physical Therapist | 2655 Ridgeway Ave, Suite 320, Rochester, NY 14626-4296 | 2016-01-19 |
| 1356706857 | Kelly A Lockwood | Physical Therapist | 2655 Ridgeway Ave, Suite 320, Rochester, NY 14626-4296 | 2015-12-28 |
| 1225493893 | Susan Thomas | Physical Therapist | 2655 Ridgeway Ave, Suite 320, Rochester, NY 14626-4296 | 2015-12-23 |
| 1245695816 | Donald Gravett | Physical Therapist | 2655 Ridgeway Ave, Suite 320, Rochester, NY 14626-4296 | 2015-12-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760978084 | Elizabeth M Neenan | Nurse Practitioner | 105 Canal Landing Blvd. Suite 1, Rochester, NY 14626 | 2018-07-10 |
| 1811488737 | Anthony Richard Mesolella | Dentist | 2081 W Ridge Rd Ste 204, Rochester, NY 14626 | 2018-05-26 |
| 1285157370 | Heather Kate Byam | Nurse Anesthetist, Certified Registered | 280 Mill Road, Rochester, NY 14626 | 2017-07-20 |
| 1710415039 | Abner O De Los Santos | Dentist | 120 Erie Canal Dr Ste 150, Rochester, NY 14626 | 2017-05-31 |
| 1609308709 | Ulfat Shafiq | Dentist | 1100 Long Pond Rd Ste 115, Greece, NY 14626 | 2017-03-29 |
| 1174982953 | S.a.v.o.c L.l.c | Preferred Provider Organization | 2833 West Ridge Road, Pearle Vision Ridgemont Plaza Suite 'a', Rochester, NY 14626 | 2016-02-22 |
| 1700244357 | Kerri Anne Sawyer | Registered Nurse | 82 Southridge Drive, Rochester, NY 14626 | 2016-02-10 |
| 1518398106 | Braces of Greece | Exclusive Provider Organization | 770 Fetzner Rd., Rochester, NY 14626 | 2013-12-06 |
| 1477983443 | Amy Pawlyk | Licensed Practical Nurse | 116 Annie Lane, Rochester, NY 14626 | 2013-11-12 |
| 1689911208 | Kathleen Zimmerman | Occupational Therapist | 1555 Long Pond Rd., 4th Floor, Rochester, NY 14626 | 2013-01-16 |
| Find all providers in zip 14626 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821220021 | Dalin Thomas Pulsipher | Clinical Neuropsychologist | 919 Westfall Rd Suite 220, Bldg C, Rochester, NY 14642-2058 | 2009-08-20 |
| 1639595879 | Renee Madathil | Clinical Neuropsychologist | 601 Elmwood Ave, Rochester, NY 14642-0001 | 2014-03-12 |
| 1972931772 | Tanya R Grace | Clinical Neuropsychologist | 2655 Ridgeway Ave, Suite 420, Rochester, NY 14626-4296 | 2013-10-15 |
| 1720239916 | Nikki Horne Stricker | Clinical Neuropsychologist | 200 1st St Sw, Rochester, MN 55905-0001 | 2008-10-06 |
| 1750538120 | Amy Pacos Martinez | Clinical Neuropsychologist | 601 Elmwood Ave, Rochester, NY 14642-2755 | 2008-08-27 |
| 1144490681 | Krista Marguerite Damann | Clinical Neuropsychologist | 2655 Ridgeway Ave, Suite 420, Rochester, NY 14626-4296 | 2008-03-11 |
| 1609956002 | Denise Llyn Henderson | Clinical Neuropsychologist | 277 Alexander St, Suite305, Rochester, NY 14607-1920 | 2006-10-17 |
| 1588757975 | Miriam T Weber | Clinical Neuropsychologist | 601 Elmwood Ave, Box 278984, Rochester, NY 14642-0001 | 2006-09-30 |
| 1760597223 | Mark Mapstone | Clinical Neuropsychologist | 601 Elmwood Ave, Rochester, NY 14642-0002 | 2006-08-21 |
| 1336254978 | John T Langfitt | Clinical Neuropsychologist | 601 Elmwood Ave, Rochester, NY 14642-0001 | 2006-08-21 |
| Find all providers in ROCHESTER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.