Healthcare Provider Details

I. General information

NPI: 1598371130
Provider Name (Legal Business Name): AZADEH HASSAN-TEHRANI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980A SHERIDAN DR STE 200
AMHERST NY
14226-1741
US

IV. Provider business mailing address

PO BOX 488
BUFFALO NY
14240-0488
US

V. Phone/Fax

Practice location:
  • Phone: 716-309-4772
  • Fax:
Mailing address:
  • Phone: 866-853-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346620
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number611615
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: