Provider Demographics
NPI:1649472788
Name:WIBBERLEY, TEDANA PRINTEMPS (MD)
Entity type:Individual
Prefix:DR
First Name:TEDANA
Middle Name:PRINTEMPS
Last Name:WIBBERLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TEDANA
Other - Middle Name:PRINTEMPS
Other - Last Name:WIBBERLEYBAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 10532
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-0532
Mailing Address - Country:US
Mailing Address - Phone:585-271-2390
Mailing Address - Fax:585-271-2877
Practice Address - Street 1:233 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2518
Practice Address - Country:US
Practice Address - Phone:585-271-2390
Practice Address - Fax:585-271-2877
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1494262083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine