Healthcare Provider Details

I. General information

NPI: 1407784119
Provider Name (Legal Business Name): TESSA SPANGENBURG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 GOODYEAR ROAD, KIMBALL TOWER
BUFFALO NY
14214
US

IV. Provider business mailing address

32 MAPLESHADE AVE
FALCONER NY
14733-1049
US

V. Phone/Fax

Practice location:
  • Phone: 716-645-2000
  • Fax:
Mailing address:
  • Phone: 716-720-3655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: