Provider Demographics
NPI:1134731961
Name:GRAMMATICO, KALEY RAE
Entity type:Individual
Prefix:
First Name:KALEY
Middle Name:RAE
Last Name:GRAMMATICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KALEY
Other - Middle Name:RAE
Other - Last Name:FALKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 COLEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1804
Mailing Address - Country:US
Mailing Address - Phone:585-409-5731
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-22
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY383181363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics