Provider Demographics
NPI:1982410213
Name:PACAVAR, LEJLA
Entity type:Individual
Prefix:
First Name:LEJLA
Middle Name:
Last Name:PACAVAR
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 1:1827 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1215
Mailing Address - Country:US
Mailing Address - Phone:585-298-0636
Mailing Address - Fax:
Practice Address - Street 1:103 CANAL LANDING BLVD STE 12
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4181
Practice Address - Country:US
Practice Address - Phone:585-227-1080
Practice Address - Fax:585-723-7709
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY355215207RG0100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology