Healthcare Provider Details

I. General information

NPI: 1245165786
Provider Name (Legal Business Name): KELLY WINKLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E NORTH ST
BUFFALO NY
14203-1002
US

IV. Provider business mailing address

99 DEER RDG
GETZVILLE NY
14068-1272
US

V. Phone/Fax

Practice location:
  • Phone: 716-885-8318
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1177131
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: