Healthcare Provider Details

I. General information

NPI: 1699440065
Provider Name (Legal Business Name): SAMANTHA EDINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 STANTON ST
BUFFALO NY
14212-1128
US

IV. Provider business mailing address

1526 WALDEN AVE STE 400
CHEEKTOWAGA NY
14225-4985
US

V. Phone/Fax

Practice location:
  • Phone: 607-229-2801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: