Provider Demographics
NPI:1356694111
Name:KRISANDA, JESSICA SUSAN
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:SUSAN
Last Name:KRISANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:SUSAN
Other - Last Name:WALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 VANTAGE POINT DR.
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ROCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:14624
Mailing Address - Country:US
Mailing Address - Phone:585-352-7775
Mailing Address - Fax:585-352-7879
Practice Address - Street 1:50 VANTAGE POINT DR
Practice Address - Street 2:SUITE 4
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1180
Practice Address - Country:US
Practice Address - Phone:585-352-7775
Practice Address - Fax:585-352-7879
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator