Basic Information
| Provider Information | |||||||||
| NPI: | 1184183592 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELIBASHI | ||||||||
| FirstName: | JERA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 KINGS HIGHWAY SOUTH | ||||||||
| Address2: | PROVIDER ENROLLMENT | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146175504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859221900 | ||||||||
| FaxNumber: | 5859220636 | ||||||||
| Practice Location | |||||||||
| Address1: | 65 GENESEE ST. , BK BUILDING 3RD FLR | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853683031 | ||||||||
| FaxNumber: | 5853683037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2019 | ||||||||
| LastUpdateDate: | 04/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 023188 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.