Provider Demographics
NPI:1932484011
Name:POLLACK, JILL CANDACE (TSHH/MSED, ATP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:CANDACE
Last Name:POLLACK
Suffix:
Gender:F
Credentials:TSHH/MSED, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4292 ROUTE 21 S
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-8937
Mailing Address - Country:US
Mailing Address - Phone:585-393-1034
Mailing Address - Fax:
Practice Address - Street 1:953 HIGH ST
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1168
Practice Address - Country:US
Practice Address - Phone:585-924-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist