Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 22DE1287734 | NY |
NPI | 1184107237 |
---|---|
Provider Name | Tiffani Devine |
First Address | Rochester, NY 14624-3134 |
Second Address | Rochester, NY 14624-3134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2018 |
Last Update Date | 13/09/2018 |