Healthcare Provider Details

I. General information

NPI: 1609622091
Provider Name (Legal Business Name): MICHELE M ROBILLARD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 CAMP RD STE 100
HAMBURG NY
14075-2600
US

IV. Provider business mailing address

4855 CAMP RD STE 100
HAMBURG NY
14075-2600
US

V. Phone/Fax

Practice location:
  • Phone: 716-646-1084
  • Fax: 716-646-0763
Mailing address:
  • Phone: 716-646-1084
  • Fax: 716-646-0763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number341034
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: