Provider Demographics
NPI:1316056286
Name:NICANDRI, KATRINA FOX (MD)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:FOX
Last Name:NICANDRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 668
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-487-3420
Mailing Address - Fax:585-334-1264
Practice Address - Street 1:500 RED CREEK DR
Practice Address - Street 2:STE 110
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4284
Practice Address - Country:US
Practice Address - Phone:585-487-3420
Practice Address - Fax:585-334-1264
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAML20007521207V00000X
NY252767207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03120716Medicaid
NY03120716Medicaid
J400004862Medicare PIN