Provider Demographics
NPI:1528171931
Name:MONACHINO, KELLY I (NP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:I
Last Name:MONACHINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LATTIMORE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4159
Mailing Address - Country:US
Mailing Address - Phone:585-275-2691
Mailing Address - Fax:585-242-8707
Practice Address - Street 1:125 LATTIMORE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4159
Practice Address - Country:US
Practice Address - Phone:585-275-2691
Practice Address - Fax:585-242-8707
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY333693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02393786Medicaid
J400007386Medicare PIN
NYJ400001812Medicare PIN
NYJ400005876Medicare PIN