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Individual

BREEANA GILLETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
601 ELMWOOD AVE, BOX 655, ROCHESTER, NY 14642-0001
(585) 341-6880
Mailing address
601 ELMWOOD AVE, BOX 655, ROCHESTER, NY 14642-0001
(585) 341-6880

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0087461
NY
363A00000X
Physician Assistant
8746
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00011220501
UNIVERA
NY
01
000570415001
BLUE CROSS BLUE SHIELD
NY
05
01618542
NY
01
050304000023
FIDELIS
NY
01
161480107
INDEPENDENT HEALTH
NY
01
P00149815
RAILROAD MEDICARE
NY
Enumeration date
06/30/2006
Last updated
07/06/2023
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