Provider Demographics
NPI:1114005360
Name:AMEDURI, CLIFFORD J (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:J
Last Name:AMEDURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:400 RED CREEK DR
Mailing Address - Street 2:STE 120
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-4273
Mailing Address - Country:US
Mailing Address - Phone:585-334-5560
Mailing Address - Fax:585-334-5581
Practice Address - Street 1:400 RED CREEK DR
Practice Address - Street 2:STE 120
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4273
Practice Address - Country:US
Practice Address - Phone:585-334-5560
Practice Address - Fax:585-334-5581
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134853-1225400000X, 2084P0800X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY134853-1OtherNEW YORK LICENSE
NY134853-1OtherNEW YORK LICENSE