Healthcare Provider Details

I. General information

NPI: 1023564234
Provider Name (Legal Business Name): SUSAN ELIZABETH NELSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14625
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 665
ROCHESTER NY
14642
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-1395
  • Fax: 585-276-1897
Mailing address:
  • Phone: 585-275-1395
  • Fax: 585-276-1897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMT210699
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number292269
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: