Healthcare Provider Details

I. General information

NPI: 1336075290
Provider Name (Legal Business Name): MAHELET M TESFAYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MOUNT HOPE AVE
ROCHESTER NY
14620-1016
US

IV. Provider business mailing address

150 MOUNT HOPE AVE
ROCHESTER NY
14620-1016
US

V. Phone/Fax

Practice location:
  • Phone: 585-287-5626
  • Fax: 585-448-0444
Mailing address:
  • Phone: 585-287-5626
  • Fax: 585-448-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3903518
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: