Provider Demographics
NPI:1780611525
Name:DEMILIO, DEBORAH (RPA-C)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:DEMILIO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 278980
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-254-1850
Mailing Address - Fax:585-254-0549
Practice Address - Street 1:200 RED CREEK DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623
Practice Address - Country:US
Practice Address - Phone:585-334-0130
Practice Address - Fax:585-254-0549
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY005145363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02407192Medicaid
NY02407192Medicaid
NYCC4571- GRP:70008AMedicare PIN
S44233Medicare UPIN