Healthcare Provider Details

I. General information

NPI: 1770496499
Provider Name (Legal Business Name): MIA ROSE CAMALLERI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 YOUNGS RD
BUFFALO NY
14221-2698
US

IV. Provider business mailing address

188 OAKWOOD AVE
EAST AURORA NY
14052-2227
US

V. Phone/Fax

Practice location:
  • Phone: 716-961-9900
  • Fax:
Mailing address:
  • Phone: 716-713-8313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: