Healthcare Provider Details

I. General information

NPI: 1548065998
Provider Name (Legal Business Name): BRIANNA VEZZOSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 SHERIDAN DR
AMHERST NY
14226-1738
US

IV. Provider business mailing address

90B EMBASSY SQ APT 5
TONAWANDA NY
14150-6916
US

V. Phone/Fax

Practice location:
  • Phone: 716-250-9999
  • Fax:
Mailing address:
  • Phone: 315-576-1474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number005090
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: