Provider Demographics
NPI:1053454884
Name:IAFRATI, NANCY S
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:S
Last Name:IAFRATI
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 1:182 HASKINS LN N
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-8957
Mailing Address - Country:US
Mailing Address - Phone:585-395-5321
Mailing Address - Fax:
Practice Address - Street 1:SUNY BROCKPORT STUDENT HEALTH CENTER
Practice Address - Street 2:350 NEW CAMPUS DRIVE
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420
Practice Address - Country:US
Practice Address - Phone:585-395-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331751363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner