Healthcare Provider Details

I. General information

NPI: 1376719617
Provider Name (Legal Business Name): SHIARA MELISSA ORTIZ-PUJOLS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX 601G
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

31 LILAC DR APT 5
ROCHESTER NY
14620-3223
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-4607
  • Fax:
Mailing address:
  • Phone: 202-329-8473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number302541-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number302541-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: