Nicole Autumn Mirjafari, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME138382 Issued in FL

Practice address

5100 W Taft Rd Ste 1B
Liverpool, NY 13088-3808

Phone

(239) 343-9888

Fax

(239) 303-0714

NPI assigned

Sep 13, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 3

Other names 1

• Nicole Autumn Smith Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: drmirjafari@pnmc.medentdirect.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1144325622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 W TAFT RD STE 1B",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883808",
            "telephone_number": "918-406-2024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 W TAFT RD STE 1B",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883808",
            "telephone_number": "239-343-9888",
            "fax_number": "239-303-0714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRJAFARI",
        "first_name": "NICOLE",
        "middle_name": "AUTUMN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-13",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "324770",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "Q0568",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OK",
            "license": "24093",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME138382",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104889000",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100768880F",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100768880I",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "SMITH",
            "middle_name": "AUTUMN",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kathy Militello, RPH
• Shirley Miller
• Ann Millet, LCSW
• Mary Kathleen Miner, RN
• Jacob Mir, PA-C
• Suman Mishra, MD
• Megan Lee Mitchell, D.M.D.
• Austin Mark Mizell, PT, DPT
• Susan Moak, RPA
• Mobile Me LLC

• Pediatrics Physician in Liverpool, NY
• Providers in Liverpool, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.