Healthcare Provider Details

I. General information

NPI: 1174121933
Provider Name (Legal Business Name): MISS DANIELLE MARIE MANTIONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 SENECA ST # 1
BUFFALO NY
14210-2662
US

IV. Provider business mailing address

2412 SENECA ST # 1
BUFFALO NY
14210-2662
US

V. Phone/Fax

Practice location:
  • Phone: 716-566-6507
  • Fax: 866-242-7286
Mailing address:
  • Phone: 716-566-6507
  • Fax: 866-242-7286

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: