Provider Demographics
NPI:1184183592
Name:DELIBASHI, JERA (PA)
Entity Type:Individual
Prefix:
First Name:JERA
Middle Name:
Last Name:DELIBASHI
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 1:100 KINGS HIGHWAY SOUTH
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-1900
Mailing Address - Fax:585-922-0636
Practice Address - Street 1:65 GENESEE ST. , BK BUILDING 3RD FLR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611
Practice Address - Country:US
Practice Address - Phone:585-368-3031
Practice Address - Fax:585-368-3037
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023188363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical