Healthcare Provider Details

I. General information

NPI: 1750245445
Provider Name (Legal Business Name): TIMOTHY DUTTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1298 MAIN ST FL 3
BUFFALO NY
14209-1946
US

IV. Provider business mailing address

227 THORN AVE
ORCHARD PARK NY
14127-2600
US

V. Phone/Fax

Practice location:
  • Phone: 716-884-5797
  • Fax: 716-882-0293
Mailing address:
  • Phone: 716-662-0019
  • Fax: 716-662-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCRPA-6155
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: