Individual
NICOLE AUTUMN MIRJAFARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5100 W TAFT RD STE 1B, LIVERPOOL, NY 13088-3808
(239) 343-9888
(239) 303-0714
Mailing address
5100 W TAFT RD STE 1B, LIVERPOOL, NY 13088-3808
(918) 406-2024
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
24093
OK
208000000X
Pediatrics Physician
324770
NY
208000000X
Pediatrics Physician
Primary
ME138382
FL
208000000X
Pediatrics Physician
Q0568
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100768880F
—
OK
05
—
100768880I
—
OK
05
—
104889000
—
FL
Enumeration date
09/13/2006
Last updated
01/25/2024
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