Provider Demographics
NPI:1659989804
Name:MILES, CHRISTOPHER GRANT (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GRANT
Last Name:MILES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-4698
Mailing Address - Fax:585-922-5702
Practice Address - Street 1:1425 PORTLAND AVE STE 206
Practice Address - Street 2:WILSON BLDG
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3011
Practice Address - Country:US
Practice Address - Phone:585-922-4698
Practice Address - Fax:585-922-5702
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402975363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health