Healthcare Provider Details

I. General information

NPI: 1124781380
Provider Name (Legal Business Name): AMANDA GYNAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM AND CARLTON ST
BUFFALO NY
14263-7529
US

IV. Provider business mailing address

199 PARK CLUB LN STE 500
WILLIAMSVILLE NY
14221-5269
US

V. Phone/Fax

Practice location:
  • Phone: 716-245-2300
  • Fax:
Mailing address:
  • Phone: 716-845-1300
  • Fax: 716-322-3372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number683915
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF311231
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: