Healthcare Provider Details

I. General information

NPI: 1144959297
Provider Name (Legal Business Name): OLIVIA GRACE CUPO AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MAIN ST STE 201
AMHERST NY
14226-4500
US

IV. Provider business mailing address

4600 MAIN ST STE 201
AMHERST NY
14226-4500
US

V. Phone/Fax

Practice location:
  • Phone: 716-833-4488
  • Fax: 716-839-1218
Mailing address:
  • Phone: 716-833-4488
  • Fax: 716-839-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: