Provider Demographics
NPI:1043636426
Name:TRAYNOR, JUDY (PMHNP)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:TRAYNOR
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19750 MINKLER RD
Mailing Address - Street 2:
Mailing Address - City:ADAMS CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13606-3122
Mailing Address - Country:US
Mailing Address - Phone:315-778-6327
Mailing Address - Fax:
Practice Address - Street 1:19750 MINKLER RD
Practice Address - Street 2:
Practice Address - City:ADAMS CENTER
Practice Address - State:NY
Practice Address - Zip Code:13606-3122
Practice Address - Country:US
Practice Address - Phone:315-778-6327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401163-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health