Provider Demographics
NPI:1083459028
Name:MCHENRY, MATTHEW SCOTT (NP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SCOTT
Last Name:MCHENRY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 WEST ST STE 500
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1722
Mailing Address - Country:US
Mailing Address - Phone:585-905-0061
Mailing Address - Fax:585-412-6612
Practice Address - Street 1:3200 WEST ST STE 500
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1722
Practice Address - Country:US
Practice Address - Phone:585-905-0061
Practice Address - Fax:585-412-6612
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311857363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health