Healthcare Provider Details

I. General information

NPI: 1255769980
Provider Name (Legal Business Name): WAYNE NUNESS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 NIAGARA ST
BUFFALO NY
14201-1886
US

IV. Provider business mailing address

430 NIAGARA ST
BUFFALO NY
14201-1886
US

V. Phone/Fax

Practice location:
  • Phone: 716-856-9711
  • Fax: 716-856-5614
Mailing address:
  • Phone: 716-856-9711
  • Fax: 716-856-5614

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: