Provider Demographics
NPI:1811574700
Name:VITTOZZI, CARLY M (CNM)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:M
Last Name:VITTOZZI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX 668
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-2691
Mailing Address - Fax:
Practice Address - Street 1:125 LATTIMORE RD STE 150
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4156
Practice Address - Country:US
Practice Address - Phone:585-275-2691
Practice Address - Fax:585-368-4009
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2073363A00000X
NY002073367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant