MEDICARE: SUSAN CALDWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	280203-1	NY

General Provider Information

NPI Number	:	1235795220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN CALDWELL

Provider Business Mailing Address
First Line	:	227 THORN AVE
Second Line	:
City	:	ORCHARD PARK
State	:	NY
Zip	:	14127-2600
Country	:	US
Telephone Number	:	716-662-2040
Fax Number	:	716-662-0019

Provider Business Practice Location Address
First Line	:	1280 MAIN ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14209-1966
Country	:	US
Telephone Number	:	716-884-5797
Fax Number	:	716-882-0293

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2019
Last Update Date	:	05/15/2019

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Directions to “ SUSAN CALDWELL ” Practice Location

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