Healthcare Provider Details

I. General information

NPI: 1245155373
Provider Name (Legal Business Name): SILAS K MOORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BRENTWOOD DR
BUFFALO NY
14227-3271
US

IV. Provider business mailing address

120 BRENTWOOD DR
BUFFALO NY
14227-3271
US

V. Phone/Fax

Practice location:
  • Phone: 716-253-7338
  • Fax:
Mailing address:
  • Phone: 716-253-7338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: SILAS K. MOORE
Title or Position: PRESIDENT
Credential:
Phone: 716-253-7338