Healthcare Provider Details

I. General information

NPI: 1265147102
Provider Name (Legal Business Name): FABIANA MARIA SANTELISES ROBLEDO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 HOOSICK ST STE K
TROY NY
12180-2393
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-268-5370
  • Fax: 518-268-5800
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number346596
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: