Healthcare Provider Details

I. General information

NPI: 1386566156
Provider Name (Legal Business Name): MS. SHELLY ANN JEMIOLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SENECA ST STE 610
BUFFALO NY
14204-1963
US

IV. Provider business mailing address

500 SENECA ST STE 610
BUFFALO NY
14204-1963
US

V. Phone/Fax

Practice location:
  • Phone: 719-881-2800
  • Fax: 866-941-4302
Mailing address:
  • Phone: 716-881-2800
  • Fax: 866-941-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number304106-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: