Provider Demographics
NPI:1548524556
Name:JAGGER, RACHAEL SARA
Entity type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:SARA
Last Name:JAGGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:SARA
Other - Last Name:AMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28 HAYWARDS HEATH
Mailing Address - Street 2:
Mailing Address - City:WEST HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-9494
Mailing Address - Country:US
Mailing Address - Phone:585-217-1175
Mailing Address - Fax:
Practice Address - Street 1:6 N MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1524
Practice Address - Country:US
Practice Address - Phone:585-377-6590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist