Provider Demographics
NPI:1639642473
Name:LEVSTIK, NICOLA SUSANNE (MBBCHBAO)
Entity Type:Individual
Prefix:
First Name:NICOLA
Middle Name:SUSANNE
Last Name:LEVSTIK
Suffix:
Gender:F
Credentials:MBBCHBAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 PANORAMA TRL
Mailing Address - Street 2:BLDG 3, STE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625
Mailing Address - Country:US
Mailing Address - Phone:585-276-9361
Mailing Address - Fax:585-248-3703
Practice Address - Street 1:625 PANORAMA TRL
Practice Address - Street 2:BLDG 3, STE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625
Practice Address - Country:US
Practice Address - Phone:585-276-9361
Practice Address - Fax:585-248-3703
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297962207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine