Healthcare Provider Details

I. General information

NPI: 1376404277
Provider Name (Legal Business Name): DESIREA BORDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 SENATOR KEATING BLVD BLDG E SUITE 3100
ROCHESTER NY
14618-2775
US

IV. Provider business mailing address

995 SENATOR KEATING BLVD BLDG E
ROCHESTER NY
14618-2775
US

V. Phone/Fax

Practice location:
  • Phone: 585-473-1750
  • Fax: 585-473-4806
Mailing address:
  • Phone: 585-473-1750
  • Fax: 585-473-4806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number686871
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: