Healthcare Provider Details

I. General information

NPI: 1306875786
Provider Name (Legal Business Name): SUSAN MASON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1083 DELAWARE AVE
BUFFALO NY
14209-1635
US

IV. Provider business mailing address

1083 DELAWARE AVE
BUFFALO NY
14209-1635
US

V. Phone/Fax

Practice location:
  • Phone: 716-882-1023
  • Fax: 716-882-1022
Mailing address:
  • Phone: 716-882-1023
  • Fax: 716-882-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0601X
TaxonomyOtorhinolaryngology & Head-Neck Registered Nurse
License Number2368121
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: