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NPI Code Detail

MEDICARE: SHANLEY BLACKLEY SIFAIN MD

MEDICARE: SHANLEY BLACKLEY SIFAIN MD
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
1208000000XPediatrics Physician276535NY
2390200000XStudent in an Organized Health Care Education/Training Program
32080N0001XNeonatal-Perinatal Medicine Physician62287TN

General Provider Information

NPI Number : 1427357938
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANLEY BLACKLEY SIFAIN MD
Provider Business Mailing Address
First Line : 601 ELMWOOD AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14642-0001
Country : US
Telephone Number : 585-275-4600
Fax Number : 585-461-1231
Provider Business Practice Location Address
First Line : 2157 MAIN ST
Second Line :
City : BUFFALO
State : NY
Zip : 14214-2648
Country : US
Telephone Number : 716-862-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2011
Last Update Date : 01/22/2021

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Directions to “ SHANLEY BLACKLEY SIFAIN MD” Practice Location

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