Provider Demographics
NPI:1346727336
Name:MILILLO, BAILEY KEM (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:BAILEY
Middle Name:KEM
Last Name:MILILLO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MISS
Other - First Name:BAILEY
Other - Middle Name:LYNN
Other - Last Name:KEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-4726
Mailing Address - Fax:585-266-5363
Practice Address - Street 1:1445 PORTLAND AVE STE 210
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621
Practice Address - Country:US
Practice Address - Phone:585-922-4726
Practice Address - Fax:585-266-5363
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022317363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical