Provider Demographics
NPI:1396839163
Name:KESHISHIAN, AMBER IRENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:IRENE
Last Name:KESHISHIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ALLENS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3305
Mailing Address - Country:US
Mailing Address - Phone:585-244-4161
Mailing Address - Fax:585-244-4159
Practice Address - Street 1:130 ALLENS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3305
Practice Address - Country:US
Practice Address - Phone:585-244-4161
Practice Address - Fax:585-244-4159
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011607-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
270727600OtherFEDERAL EMPLOYMENT NUMBER