Healthcare Provider Details

I. General information

NPI: 1437324548
Provider Name (Legal Business Name): OLHA ANNA O'QUINN PHD, CDN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLHA ANNA SHEVCHUK PHD, CDN

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 DELAWARE AVE
BUFFALO NY
14209-2202
US

IV. Provider business mailing address

36 WYETH DR
GETZVILLE NY
14068-1244
US

V. Phone/Fax

Practice location:
  • Phone: 716-431-5100
  • Fax:
Mailing address:
  • Phone: 917-922-5326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number003057-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number2052-0329
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: