Provider Demographics
NPI:1407565591
Name:HERON, SAUDIA CAMILLE
Entity Type:Individual
Prefix:
First Name:SAUDIA
Middle Name:CAMILLE
Last Name:HERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 FLANDERS ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-1708
Mailing Address - Country:US
Mailing Address - Phone:585-957-3527
Mailing Address - Fax:
Practice Address - Street 1:126 FLANDERS ST APT 2
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-1708
Practice Address - Country:US
Practice Address - Phone:585-957-5017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334960164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse