Provider Demographics
NPI:1184971616
Name:DOBSTAFF, IRENE (MSED)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:DOBSTAFF
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ROLLING PLNS
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-9020
Mailing Address - Country:US
Mailing Address - Phone:585-770-0235
Mailing Address - Fax:
Practice Address - Street 1:11 ROLLING PLNS
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14472-9020
Practice Address - Country:US
Practice Address - Phone:585-770-0235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4390171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor