Provider Demographics
NPI:1457017519
Name:DEFORD, HEIDI M (NP)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:M
Last Name:DEFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 PHELPS RD
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-9037
Mailing Address - Country:US
Mailing Address - Phone:585-880-5102
Mailing Address - Fax:
Practice Address - Street 1:6280 FURNACE RD STE 600
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:NY
Practice Address - Zip Code:14519-8974
Practice Address - Country:US
Practice Address - Phone:585-880-5102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY425907163WW0101X
NYF349758-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY425907Medicaid