Healthcare Provider Details

I. General information

NPI: 1285837260
Provider Name (Legal Business Name): NELLY ORTA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 MAPLE RD
AMHERST NY
14226-1027
US

IV. Provider business mailing address

4350 MAPLE RD
AMHERST NY
14226-1027
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-3316
  • Fax: 716-829-2564
Mailing address:
  • Phone: 716-829-3316
  • Fax: 716-829-2564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number005993
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: