Healthcare Provider Details

I. General information

NPI: 1164805461
Provider Name (Legal Business Name): BRANDI STREETER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 WILLIAM ST
BUFFALO NY
14204-1811
US

IV. Provider business mailing address

1526 WALDEN AVENUE SUITE 400
CHEEKTOWAGA NY
14225-4985
US

V. Phone/Fax

Practice location:
  • Phone: 716-893-0062
  • Fax: 716-893-0070
Mailing address:
  • Phone: 716-895-6700
  • Fax: 716-895-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: