Provider Demographics
NPI:1568868982
Name:PAYTASH, LAURA MADORE (FNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MADORE
Last Name:PAYTASH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BARRETT DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2963
Mailing Address - Country:US
Mailing Address - Phone:585-872-1003
Mailing Address - Fax:
Practice Address - Street 1:60 BARRETT DR
Practice Address - Street 2:SUITE A
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2963
Practice Address - Country:US
Practice Address - Phone:585-872-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily