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NPI Code Detail

MEDICARE: MADISON SIERRA NIEVES

MEDICARE: MADISON SIERRA NIEVES
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
1363AS0400XSurgical Physician AssistantNY
2363A00000XPhysician Assistant034570NY
3363AM0700XMedical Physician AssistantNY

General Provider Information

NPI Number : 1467275065
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON SIERRA NIEVES
Provider Business Mailing Address
First Line : 38 PLYMOUTH AVE
Second Line :
City : BUFFALO
State : NY
Zip : 14201-1722
Country : US
Telephone Number : 571-524-0198
Fax Number :
Provider Business Practice Location Address
First Line : 38 PLYMOUTH AVE
Second Line :
City : BUFFALO
State : NY
Zip : 14201-1722
Country : US
Telephone Number : 571-524-0198
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2024
Last Update Date : 12/02/2025

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Directions to “ MADISON SIERRA NIEVES ” Practice Location

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