Healthcare Provider Details

I. General information

NPI: 1225613615
Provider Name (Legal Business Name): NADINE ABDELLATIF DNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 W HUMBOLDT PKWY
BUFFALO NY
14214-2604
US

IV. Provider business mailing address

95 W HUMBOLDT PKWY
BUFFALO NY
14214-2604
US

V. Phone/Fax

Practice location:
  • Phone: 716-710-5151
  • Fax:
Mailing address:
  • Phone: 716-710-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number802701
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406075
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: