MEDICARE: MRS. MITA MOORTHI FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	334657	NY
2	363LF0000X	Family Nurse Practitioner	482708-1	NY

General Provider Information

NPI Number	:	1306829692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MITA MOORTHI FNP

Provider Business Mailing Address
First Line	:	PO BOX 18125
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-0125
Country	:	US
Telephone Number	:	585-271-1620
Fax Number	:	585-271-1634

Provider Business Practice Location Address
First Line	:	2561 LAC DE VILLE BLVD
Second Line	:	STE 201
City	:	ROCHESTER
State	:	NY
Zip	:	14618-5645
Country	:	US
Telephone Number	:	585-271-1620
Fax Number	:	585-271-1634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	06/29/2023

Similar Medicare Providers

1811990286 — DR. PAUL C HARRINGTON M.D.
Practice Location Address:

2561 LAC DE VILLE BLVD , STE 100
ROCHESTER, NY
14618-5645

Practice Phone: 585-244-3510
Practice Fax: 585-244-3519

1346242658 — LORALEE SPARACINO N.P.
Practice Location Address:

2561 LAC DE VILLE BLVD , STE 100
ROCHESTER, NY
14618-5645

Practice Phone: 585-244-3510
Practice Fax: 585-244-3519

1194717488 — DR. ELIZABETH ANN ORLANDO AUD
Practice Location Address:

2561 LAC DE VILLE BLVD , SUITE 101
ROCHESTER, NY
14618-5645

Practice Phone: 585-461-9192
Practice Fax: 585-461-9196

1992798227 — MS. SHANNON CHRISTINE MANZO AUD
Practice Location Address:

2561 LAC DE VILLE BLVD , STE 101
ROCHESTER, NY
14618-5645

Practice Phone: 585-461-9192
Practice Fax: 585-461-9196

1841286598 — DR. SHEILA M DALZELL AU.D.
Practice Location Address:

2561 LAC DE VILLE BLVD , SUITE 101
ROCHESTER, NY
14618-5645

Practice Phone: 585-461-9192
Practice Fax: 585-461-9196

1942278718 — DR. LARRY EUGENE DALZELL PH.D.
Practice Location Address:

2561 LAC DE VILLE BLVD , # 101
ROCHESTER, NY
14618-5645

Practice Phone: 585-461-9192
Practice Fax: 585-461-9196

Directions to “ MRS. MITA MOORTHI FNP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.