Healthcare Provider Details

I. General information

NPI: 1518403963
Provider Name (Legal Business Name): TENIKA ELDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 STEWART AVE
BUFFALO NY
14211-2614
US

IV. Provider business mailing address

48 STEWART AVE
BUFFALO NY
14211-2614
US

V. Phone/Fax

Practice location:
  • Phone: 716-536-8163
  • Fax:
Mailing address:
  • Phone: 716-536-8163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number614745
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: