Healthcare Provider Details

I. General information

NPI: 1760318745
Provider Name (Legal Business Name): MICHELA SILIVESTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 DRIVING PARK AVE
NEWARK NY
14513-1090
US

IV. Provider business mailing address

1200 DRIVING PARK AVE
NEWARK NY
14513-1090
US

V. Phone/Fax

Practice location:
  • Phone: 315-332-2022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number036269
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: