Healthcare Provider Details

I. General information

NPI: 1205590627
Provider Name (Legal Business Name): MIRELA QUWATLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 GENESEE ST
ROCHESTER NY
14611-3201
US

IV. Provider business mailing address

50 FAIRWOOD DR APT 364
ROCHESTER NY
14623-4958
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-3950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: