Healthcare Provider Details

I. General information

NPI: 1952816159
Provider Name (Legal Business Name): TAUREAN TOMORROW DEANDREAS REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2017
Last Update Date: 12/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 GEORGIA ST
BUFFALO NY
14201-2307
US

IV. Provider business mailing address

267 GEORGIA ST
BUFFALO NY
14201-2307
US

V. Phone/Fax

Practice location:
  • Phone: 716-243-2762
  • Fax:
Mailing address:
  • Phone: 716-243-2762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number728277
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number728277
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number728277
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: