Healthcare Provider Details

I. General information

NPI: 1033793625
Provider Name (Legal Business Name): SHIRLEY BOTROS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER ST STE 1152
BUFFALO NY
14215-3021
US

IV. Provider business mailing address

462 GRIDER ST STE 1152
BUFFALO NY
14215-3021
US

V. Phone/Fax

Practice location:
  • Phone: 716-898-4803
  • Fax:
Mailing address:
  • Phone: 716-898-4803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number342500
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: