Healthcare Provider Details

I. General information

NPI: 1144699281
Provider Name (Legal Business Name): SUSAN EDERER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 DELAWARE AVE
BUFFALO NY
14202-3812
US

IV. Provider business mailing address

309 WILLOW RIDGE DR
AMHERST NY
14228-3053
US

V. Phone/Fax

Practice location:
  • Phone: 716-852-5900
  • Fax:
Mailing address:
  • Phone: 716-583-0432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number22 378906
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: