Healthcare Provider Details

I. General information

NPI: 1134865850
Provider Name (Legal Business Name): ALICIA NICOLE GAYLEEN DRAGO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date: 12/13/2022
Reactivation Date: 02/17/2023

III. Provider practice location address

818 ELLICOTT ST.
BUFFALO NY
14203
US

IV. Provider business mailing address

1001 MAIN ST FL 5
BUFFALO NY
14203-1009
US

V. Phone/Fax

Practice location:
  • Phone: 716-323-2000
  • Fax: 716-323-0292
Mailing address:
  • Phone: 716-323-0225
  • Fax: 716-323-0293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number338745
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: