Healthcare Provider Details

I. General information

NPI: 1154111466
Provider Name (Legal Business Name): YUTAKA SHISHIDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX SURG
ROCHESTER NY
14642-8410
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX SURG
ROCHESTER NY
14642-8410
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-5875
  • Fax: 585-271-7929
Mailing address:
  • Phone: 585-275-5875
  • Fax: 585-271-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number334729
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: