Provider Demographics
NPI:1053727941
Name:PALERMO, COLLEEN (DNP, FNP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:PALERMO
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-368-3506
Mailing Address - Fax:585-368-3163
Practice Address - Street 1:89 GENESEE ST
Practice Address - Street 2:BK BUILDING, 3RD FLOOR
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-3201
Practice Address - Country:US
Practice Address - Phone:585-368-3506
Practice Address - Fax:585-368-3163
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03913320Medicaid
NYJ400161779/GRP70008AMedicare PIN
NYJ400161780/GRPBA0017Medicare PIN