Provider Demographics
NPI:1598347171
Name:BRADY, JAIME L (NP)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:L
Last Name:BRADY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:L
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1415 PORTLAND AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3022
Mailing Address - Country:US
Mailing Address - Phone:585-922-3260
Mailing Address - Fax:585-922-3261
Practice Address - Street 1:1415 PORTLAND AVE STE 240
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3022
Practice Address - Country:US
Practice Address - Phone:585-922-3260
Practice Address - Fax:585-922-3261
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY432006363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner