Individual
ASHLEY E MANCUSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
164 JEFFERSON AVE, FAIRPORT, NY 14450-1912
(585) 770-3356
Mailing address
164 JEFFERSON AVE, FAIRPORT, NY 14450-1912
(585) 770-3356
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
7384841
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
357730319
DRIVES LISCENCE
NY
Enumeration date
08/18/2019
Last updated
08/18/2019
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