Provider Demographics
NPI:1285837260
Name:ORTA, NELLY (PA)
Entity Type:Individual
Prefix:
First Name:NELLY
Middle Name:
Last Name:ORTA
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:3435 MAIN ST
Mailing Address - Street 2:115 MICHAEL HALL
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-3001
Mailing Address - Country:US
Mailing Address - Phone:716-829-5633
Mailing Address - Fax:716-829-2564
Practice Address - Street 1:3435 MAIN ST
Practice Address - Street 2:115 MICHAEL HALL
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-3001
Practice Address - Country:US
Practice Address - Phone:716-829-5633
Practice Address - Fax:716-829-2564
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2013-03-04
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Provider Licenses
StateLicense IDTaxonomies
NY005993363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical