Healthcare Provider Details

I. General information

NPI: 1427357938
Provider Name (Legal Business Name): SHANLEY BLACKLEY SIFAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 MAIN ST
BUFFALO NY
14214-2648
US

IV. Provider business mailing address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 716-862-1000
  • Fax:
Mailing address:
  • Phone: 585-275-4600
  • Fax: 585-461-1231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number276535
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number62287
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: