Provider Demographics
NPI:1790058162
Name:SPENCERPORT SCHOOLS
Entity Type:Organization
Organization Name:SPENCERPORT SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVORE
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:585-349-5352
Mailing Address - Street 1:2749 SPENCERPORT RD
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1942
Mailing Address - Country:US
Mailing Address - Phone:585-349-5352
Mailing Address - Fax:585-349-5386
Practice Address - Street 1:2749 SPENCERPORT RD
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1942
Practice Address - Country:US
Practice Address - Phone:585-349-5352
Practice Address - Fax:585-349-5386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231927-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty