KELLEYAYN WALLACE (NPI# 1831290717) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831290717 |
| Entity Type | Individual |
| Full Name | KELLEYAYN WALLACE |
| Credential | PA |
| Practice Address |
2080 Clinton Ave South Rochester NY 14618 |
| Practice Telephone | 5852712800 |
| Practice Fax Number | 5852710375 |
| Mailing Telephone | 5852712800 |
| Mailing Fax Number | 5852710375 |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2015-12-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 011509 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | MEDICARE RAILROAD | CF8438 | 01 |
| NY | GROUP NPI | 1366535940 | 01 |
| NY | AETNA | 7082043 | 01 |
| NY | 02578343 | 05 | |
| EXCELLUS | G0183898590 | 01 |
| Street Address |
2080 CLINTON AVE SOUTH |
| City | ROCHESTER |
| State | NY |
| Zip Code | 14618 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134102700 | Paul S Dziwis | Internal Medicine | 2080 Clinton Ave South, Rochester, NY 14618 | 2005-11-28 |
| 1699928770 | Julie Ann Lawatsch | Physician Assistant | 2080 Clinton Ave South, Rochester, NY 14618 | 2008-11-03 |
| 1396822706 | Jonathan I. Goldstein | Internal Medicine | 2080 Clinton Ave South, Rochester, NY 14618 | 2006-11-01 |
| 1972611796 | Keely R Parisian | Internal Medicine | 2080 Clinton Ave South, Rochester, NY 14618 | 2006-08-29 |
| 1750399028 | Bushra Fazili | Internal Medicine | 2080 Clinton Ave South, Rochester, NY 14618 | 2006-08-03 |
| 1306854682 | Michael E Kader | Internal Medicine | 2080 Clinton Ave South, Rochester, NY 14618 | 2006-08-03 |
| 1659356541 | George Young Kunze | Internal Medicine | 2080 Clinton Ave South, Rochester, NY 14618 | 2005-12-13 |
| 1760466254 | Anil Kumar Sharma | Internal Medicine | 2080 Clinton Ave South, Rochester, NY 14618 | 2005-11-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962056499 | Zahavi Dental of Rochester | Dentist | 1815 S. Clinton Ave, 510, Rocheter, NY 14618 | 2019-08-01 |
| 1760047278 | Inner Power Physical Therapy Pllc | Clinic/Center | 2561 Lac Deville Boulevard, Suite 100, Rochester, NY 14618 | 2019-05-09 |
| 1659859858 | Steven Sanfilippo | Counselor | 2000 S. Winton Rd., Building 4, Suite 303, Rochester, NY 14618 | 2018-07-31 |
| 1578064853 | Feet First Inc | Durable Medical Equipment & Medical Supplies | 1900 Clinton Ave S Ste 5, Rochester, NY 14618 | 2018-02-22 |
| 1558805374 | Jennifer Virella | Social Worker | 2000 South Winton Road, Bldg 2, Rochester, NY 14618 | 2016-12-13 |
| 1235589300 | Andrew Cyrus Marcy | Nurse Practitioner | 95 Allens Creek Road Bld 1 Ste 306, Rochester, NY 14618 | 2016-06-20 |
| 1932561073 | Legacy Pediatrics | Pediatrics | 1815 South Clinton Avenue Ste 360, Rochester, NY 14618 | 2016-03-28 |
| 1790143105 | Marie Lynn Bieber | Dietitian, Registered | 919 Winton Rd S Ste 220, Rochester, NY 14618 | 2016-02-01 |
| 1720443096 | Brittany Rose Masetta | Marriage & Family Therapist | 2000 S Winton Rd, Bldg 4, Suite #200, Rochester, NY 14618 | 2015-12-30 |
| 1437543097 | Kathleen Skye Kemp | Internal Medicine | 2400 S Clinton Ave Ste G2, Rochester, NY 14618 | 2015-03-22 |
| Find all providers in zip 14618 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073112009 | Reece Edward Mcevoy | Physician Assistant | 2638 Sand Trap Rd Se, Rochester, MN 55904-3904 | 2020-10-21 |
| 1336755065 | Katherine Zazulak | Physician Assistant | Ur Medicine Strong Memorial Hospital 601 Elmwood Ave, Rochester, NY 14642-0001 | 2020-09-18 |
| 1609489632 | Michelle Sierant | Physician Assistant | 4847 Carrington Dr, Rochester, MI 48306-1496 | 2020-08-28 |
| 1558971812 | Kelly Ann Probst | Physician Assistant | 136 Seminole Way, Rochester, NY 14618-1348 | 2020-08-03 |
| 1750999645 | Paulina Maria Mager | Physician Assistant | 52 Pennwood Dr Apt E, Rochester, NY 14625-2527 | 2020-07-17 |
| 1013534841 | Andrew Mcleod | Physician Assistant | 4631 Deer Springs Ct, Rochester, MI 48306-4733 | 2020-06-27 |
| 1295359123 | Jenna Geary | Physician Assistant | 193 Avon Rd, Rochester, NY 14625-1932 | 2020-06-06 |
| 1063047637 | Megan Thornton | Physician Assistant | Mayo Clinic - Rochester 200 First Street Sw, Rochester, MN 55905-0001 | 2020-03-04 |
| 1609417617 | Maisie Katherine Pipher | Physician Assistant | 110 Crittenden Blvd, Rochester, NY 14620 | 2019-10-01 |
| 1427525633 | Eric Thomas Mundt | Physician Assistant | 393 Pemberton Road, Rochester, NY 14622 | 2018-10-25 |
| Find all providers in ROCHESTER | ||||
Please comment or provide details below to improve the information on KELLEYAYN WALLACE.
| 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.