Provider Demographics
NPI:1952659104
Name:FELLOWS, MICHALENA (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHALENA
Middle Name:
Last Name:FELLOWS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHALENA
Other - Middle Name:
Other - Last Name:GROSSHANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:601 ELMWOOD AVE # 655
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:585-273-4398
Mailing Address - Fax:
Practice Address - Street 1:1300 JEFFERSON RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-3195
Practice Address - Country:US
Practice Address - Phone:585-413-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
NY018419363A00000X
NY18419363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical