Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 206166 | NY |
Y | 2080A0000X | Adolescent Medicine | 206166 | NY |
NPI | 1023050309 |
---|---|
Provider Name | Cheryl Kodjo |
First Address | Rochester, NY 14642-0001 |
Second Address | Rochester, NY 14642-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 25/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02244177 | (05) | NY |