Healthcare Provider Details

I. General information

NPI: 1003736711
Provider Name (Legal Business Name): ANGELIQUE HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SENECA ST STE 610
BUFFALO NY
14204-1963
US

IV. Provider business mailing address

78 N MAPLEMERE RD
WILLIAMSVILLE NY
14221-3122
US

V. Phone/Fax

Practice location:
  • Phone: 716-881-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number3771521
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: