Provider Demographics
NPI:1700328200
Name:MUNDA, PIKO
Entity Type:Individual
Prefix:
First Name:PIKO
Middle Name:
Last Name:MUNDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:VELOCITY
Other - Middle Name:
Other - Last Name:TRANSIT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:71 AVERILL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-1205
Mailing Address - Country:US
Mailing Address - Phone:585-802-8231
Mailing Address - Fax:
Practice Address - Street 1:71 AVERILL AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1205
Practice Address - Country:US
Practice Address - Phone:585-802-8231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY471727289OtherMEDICAL TRANSPORTATION