Provider Demographics
NPI:1235211384
Name:ALLERTON, HEATHER MAUREEN (RPAC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MAUREEN
Last Name:ALLERTON
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2733
Mailing Address - Country:US
Mailing Address - Phone:585-341-8485
Mailing Address - Fax:585-341-8326
Practice Address - Street 1:400 RED CREEK DR
Practice Address - Street 2:120
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4273
Practice Address - Country:US
Practice Address - Phone:585-334-5580
Practice Address - Fax:585-334-5581
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5553363AS0400X
NY005553363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA2387Medicare PIN