Healthcare Provider Details

I. General information

NPI: 1275315046
Provider Name (Legal Business Name): JO ANN PELLEGRINO PH. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 NIAGARA ST
BUFFALO NY
14213-2001
US

IV. Provider business mailing address

1050 NIAGARA ST
BUFFALO NY
14213-2001
US

V. Phone/Fax

Practice location:
  • Phone: 716-884-0888
  • Fax:
Mailing address:
  • Phone: 716-884-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number494555
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: