Provider Demographics
NPI:1588006811
Name:DONOFRIO, KIERNAN ZAMPERETTI
Entity Type:Individual
Prefix:
First Name:KIERNAN
Middle Name:ZAMPERETTI
Last Name:DONOFRIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIERNAN
Other - Middle Name:
Other - Last Name:ZAMPERETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4531 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-8227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 RED CREEK DR
Practice Address - Street 2:SUITE 220
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4273
Practice Address - Country:US
Practice Address - Phone:585-487-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337957363LF0000X
NYF337957-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily