Healthcare Provider Details

I. General information

NPI: 1669600599
Provider Name (Legal Business Name): DR. LATA SHENOY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SQUIRE HALL 3435 MAIN STREET
BUFFALO NY
14214-8006
US

IV. Provider business mailing address

4488 EAST OVERLOOK DRIVE
WILLIAMSVILLE NY
14221
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-2862
  • Fax:
Mailing address:
  • Phone: 716-631-8736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number033286
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: