Healthcare Provider Details

I. General information

NPI: 1972700888
Provider Name (Legal Business Name): JEWELL ANN HENLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH ST
BUFFALO NY
14203-1126
US

IV. Provider business mailing address

184 BARTON ST
BUFFALO NY
14213-1573
US

V. Phone/Fax

Practice location:
  • Phone: 716-859-5600
  • Fax: 716-630-1348
Mailing address:
  • Phone: 716-348-3000
  • Fax: 716-881-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number278784
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: