Healthcare Provider Details

I. General information

NPI: 1528890423
Provider Name (Legal Business Name): DEANDRA LESANTI BSN. RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 ELM ST
BUFFALO NY
14203-1621
US

IV. Provider business mailing address

83 GREGORY DR
WEST SENECA NY
14224-1058
US

V. Phone/Fax

Practice location:
  • Phone: 716-854-2444
  • Fax: 716-854-4671
Mailing address:
  • Phone: 716-361-4462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number829172
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: