Provider Demographics
NPI:1093031486
Name:SHIFERA, AMDE SELASSIE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:AMDE SELASSIE
Middle Name:
Last Name:SHIFERA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:GENENE
Other - Middle Name:SHIFERA
Other - Last Name:SIAMREGN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:601 ELMWOOD AVE BOX 888
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-273-3937
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-2515
Practice Address - Country:US
Practice Address - Phone:585-273-3937
Practice Address - Fax:813-783-2856
Is Sole Proprietor?:No
Enumeration Date:2010-04-11
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302114207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology