Healthcare Provider Details

I. General information

NPI: 1811710890
Provider Name (Legal Business Name): NICOLE I CUEVAS RIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 NIAGARA ST
BUFFALO NY
14213-2001
US

IV. Provider business mailing address

1050 NIAGARA ST
BUFFALO NY
14213-2001
US

V. Phone/Fax

Practice location:
  • Phone: 716-218-2100
  • Fax: 716-856-2608
Mailing address:
  • Phone: 716-218-2100
  • Fax: 716-856-2608

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: