Individual
BLESILDA S SO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
15 S MAIN ST, SUITE 130, JAMESTOWN, NY 14701-6636
(716) 483-3520
(716) 483-3593
Mailing address
15 S MAIN ST, SUITE 300, JAMESTOWN, NY 14701-6636
(716) 483-3520
(716) 483-3593
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
227236
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2360098
—
NY
01
—
J400168913
MEDICARE PTAN
NY
Enumeration date
06/06/2006
Last updated
02/18/2016
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