Provider Demographics
NPI:1205564416
Name:WOODCOCK, MCKAYLLE JEAN (PA-C)
Entity type:Individual
Prefix:
First Name:MCKAYLLE
Middle Name:JEAN
Last Name:WOODCOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 SENATOR KEATING BLVD.
Mailing Address - Street 2:BLDG E, SUITE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2776
Mailing Address - Country:US
Mailing Address - Phone:585-602-0500
Mailing Address - Fax:
Practice Address - Street 1:995 SENATOR KEATING BLVD.
Practice Address - Street 2:BLDG E, SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2776
Practice Address - Country:US
Practice Address - Phone:585-602-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028664363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant