Healthcare Provider Details

I. General information

NPI: 1376450320
Provider Name (Legal Business Name): KANDY ROBERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SENECA ST
BUFFALO NY
14204-1963
US

IV. Provider business mailing address

383 MONROE ST
BUFFALO NY
14212-1029
US

V. Phone/Fax

Practice location:
  • Phone: 716-609-0703
  • Fax:
Mailing address:
  • Phone: 716-609-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number308947
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: