MEDICARE: DR. NICOLE MARIE RIEDY D.O.

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	207R00000X	Internal Medicine Physician	263880	NY
2	208000000X	Pediatrics Physician	263880	NY

General Provider Information

NPI Number	:	1730410762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE MARIE RIEDY D.O.

Provider Business Mailing Address
First Line	:	56 CASPIAN CT
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14228-1654
Country	:	US
Telephone Number	:	716-861-3537
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 MAPLE RD
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-2780
Country	:	US
Telephone Number	:	716-634-5410
Fax Number	:	716-634-0430

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

Provider Enumeration Date	:	01/14/2010
Last Update Date	:	08/28/2012

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