Healthcare Provider Details

I. General information

NPI: 1962732792
Provider Name (Legal Business Name): MAGDALENE SHUSER TUKOV-YUAL ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4979 HARLEM ROAD
AMHERST NY
14228
US

IV. Provider business mailing address

4979 HARLEM ROAD
AMHERST NY
14228
US

V. Phone/Fax

Practice location:
  • Phone: 716-923-4380
  • Fax: 716-923-4384
Mailing address:
  • Phone: 716-923-4380
  • Fax: 716-923-4384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF304890-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: