Provider Demographics
NPI:1851610026
Name:MALLABER, PATRICIA RENEE (DNP, ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:RENEE
Last Name:MALLABER
Suffix:
Gender:F
Credentials:DNP, ANP-BC
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:RENEE
Other - Last Name:SANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:WILMOT CANCER CENTER BOX 704
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-5823
Mailing Address - Fax:585-273-5761
Practice Address - Street 1:125 RED CREEK DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4272
Practice Address - Country:US
Practice Address - Phone:585-486-0600
Practice Address - Fax:585-273-5761
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305384363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner