Individual
ALLISON JACKLYN D'ANGELO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
601 ELMWOOD AVE, ROCHESTER, NY 14642-0001
(585) 275-4711
Mailing address
111 CAMPBELL RD, SPENCERPORT, NY 14559-9519
(585) 478-3792
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
022421
NY
363A00000X
Physician Assistant
22421
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022421
STATE LICENSE
NY
Enumeration date
08/01/2018
Last updated
06/30/2023
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