Healthcare Provider Details

I. General information

NPI: 1760565105
Provider Name (Legal Business Name): LUCY DIANE MASTRANDREA MD, PH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST FL 4
BUFFALO NY
14203-1009
US

IV. Provider business mailing address

1001 MAIN ST FL 5
BUFFALO NY
14203-1009
US

V. Phone/Fax

Practice location:
  • Phone: 716-323-0170
  • Fax: 716-323-0297
Mailing address:
  • Phone: 716-323-0170
  • Fax: 716-323-0297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number223316
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: