Provider Demographics
NPI:1457017519
Name:DEFORD, HEIDI M (NP)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:M
Last Name:DEFORD
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:42 NICHOLS ST STE 10
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-2196
Mailing Address - Country:US
Mailing Address - Phone:585-637-7558
Mailing Address - Fax:
Practice Address - Street 1:42 NICHOLS ST STE 10
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-2196
Practice Address - Country:US
Practice Address - Phone:585-637-7558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF349758-01363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY425907Medicaid