Provider Demographics
NPI:1134278823
Name:FOOTE, COLLEEN SUE (PA)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:SUE
Last Name:FOOTE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6576 WOODLAND TRL
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-9372
Mailing Address - Country:US
Mailing Address - Phone:585-393-0198
Mailing Address - Fax:
Practice Address - Street 1:35 LYON ST.
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:NY
Practice Address - Zip Code:14512
Practice Address - Country:US
Practice Address - Phone:585-374-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003470-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant