Healthcare Provider Details

I. General information

NPI: 1437365277
Provider Name (Legal Business Name): MARIA CYNTHIA AVENDANO ENECILLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 PORTLAND AVE STE 200
ROCHESTER NY
14621-3022
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-0390
  • Fax: 585-922-0395
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number227228
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: