Healthcare Provider Details

I. General information

NPI: 1639773476
Provider Name (Legal Business Name): KHADIJAH WINKELMAN MHC-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SENECA ST FL 29
BUFFALO NY
14203-2734
US

IV. Provider business mailing address

1 SENECA ST FL 29
BUFFALO NY
14203-2734
US

V. Phone/Fax

Practice location:
  • Phone: 716-289-1865
  • Fax: 716-306-4207
Mailing address:
  • Phone: 716-289-1865
  • Fax: 716-306-4207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: