Individual provider Active NPI

Fatima Laura Mejia-Connolly, DO

  • Pediatric Critical Care Medicine Physician
  • Syracuse, NY
National Provider Identifier
1477046183
Registry record updated Jun 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
336085 Issued in NY
Practice address
750 East Adams St
Syracuse, NY 13210-2306
Phone
(315) 464-5450
Fax
(315) 464-6322
NPI assigned
Jun 8, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 0102207256 VA
Pediatric Critical Care Medicine Physician 2080P0203X 336085 NY Primary

Addresses

Primary practice location

750 East Adams St
Syracuse, NY 13210-2306

Mailing address

750 East Adams St
Syracuse, NY 13210-2306
Phone (315) 464-5450

Other practice location 1

707 E Main St
Middletown, NY 10940-2667
Phone (845) 333-6333

Other practice location 2

7101 Jahnke Rd
Richmond, VA 23225-4017
Phone (804) 320-3911

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, NY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240605003494 VA Practitioner - Pediatric Medicine 3173907359 Reassigns benefits to 1 organization
I20250630000268 NY Practitioner - Pediatric MedicinePractitioner - Critical Care (Intensivists) 3173907359 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Intensivist Services PC CurrentSince May 1, 2024 Accepting new patients
Pediatric Service Group Pediatrics CurrentSince Jul 1, 2025 Accepting new patients
Pediatrix Medical Group PC Pediatrics Past Accepting new patients
Suny Health Science Center at Syracuse Past Accepting new patients

Locations

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

1401 Johnston Willis Dr
North Chesterfield, VA 23235
Phone (804) 327-4046

7101 Jahnke Rd
Richmond, VA 23225
Phone (804) 323-1088

Interoperability endpoints

  • Direct secure messaging: fmejiaconnolly90211@direct.upstate.edu

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1528416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750464000000",
    "number": "1477046183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 EAST ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306",
            "telephone_number": "315-464-5450",
            "fax_number": "315-464-6322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 EAST ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306",
            "telephone_number": "315-464-5450",
            "fax_number": "315-464-6322"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "707 E Main St",
            "address_purpose": "LOCATION",
            "city": "Middletown",
            "state": "NY",
            "postal_code": "109402667",
            "country_code": "US",
            "telephone_number": "845-333-6333",
            "fax_number": "845-333-7342",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7101 Jahnke Rd",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232254017",
            "country_code": "US",
            "telephone_number": "804-320-3911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEJIA-CONNOLLY",
        "first_name": "FATIMA",
        "middle_name": "LAURA",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-08",
        "last_updated": "2025-06-21",
        "certification_date": "2025-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0102207256",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "NY",
            "license": "336085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.