Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 257072 | NV |
N | 2080A0000X | Adolescent Medicine | 257072 | NY |
NPI | 1265556690 |
---|---|
Provider Name | Dr. Le Keyah Wilson |
First Address | Rochester, NY 14617-5504 |
Second Address | Rochester, NY 14621-3001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 30/04/2021 |