Healthcare Provider Details

I. General information

NPI: 1609366525
Provider Name (Legal Business Name): SUSANA RUANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST
BUFFALO NY
14203
US

IV. Provider business mailing address

1001 MAIN ST
BUFFALO NY
14203
US

V. Phone/Fax

Practice location:
  • Phone: 716-323-6491
  • Fax:
Mailing address:
  • Phone: 716-323-6491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number311376-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: