Provider Demographics
NPI:1669214532
Name:GAYLE, JENNIFER SUE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:GAYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 FAIRPORT NINE MILE POINT RD STE 400
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1749
Mailing Address - Country:US
Mailing Address - Phone:585-388-6000
Mailing Address - Fax:585-388-6004
Practice Address - Street 1:2060 FAIRPORT NINE MILE POINT RD STE 400
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1749
Practice Address - Country:US
Practice Address - Phone:585-388-6000
Practice Address - Fax:585-388-6004
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY405887363L00000X
NY677450163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult