Provider Demographics
NPI:1912535386
Name:ASTUDILLO, PRISCILLA SABRINA (RN)
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:SABRINA
Last Name:ASTUDILLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WHITE SPRUCE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1610
Mailing Address - Country:US
Mailing Address - Phone:585-292-5830
Mailing Address - Fax:
Practice Address - Street 1:103 WHITE SPRUCE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1610
Practice Address - Country:US
Practice Address - Phone:585-292-5830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY787439-01163WP0808X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health